Casual Payroll Account Request Form

Please print a copy and fill out form completely.

School/Office Name: ____________________________________________  

District/Office Code: _____                                               Org ID: ______________

Contact Name: ________________________________ Contact Phone #: _________________

Budget Account Login Name (username):  B_

                                                                ____________________

 

Account Duration:   Summer School Only       Year-Round

Reason for Request:  

 

 

 

When completed, please fax to: 586-3298, someone from NSSB will contact you.

 

___________________________________

___________________________________

Requestor's Signature

Date

 

 

___________________________________

___________________________________

Principal/Supervisor's Signature

Date