Rev. 6 - 30 - 06
BUFFALO BOARD OF EDUCATION
Payroll Department
814 City Hall
Buffalo, NY 14202
Dr. James Williams
Superintendent of Schools
Direct Deposit Enrollment / Change Form
To enroll in Direct Deposit, simply fill out PART ONE of this form and return it to the Board of Education Payroll Department.
Attach a voided check for each checking account
, not a deposit slip. If depositing to a savings account, ask your
bank to give you the Routing/Transit Number for your account. It isn’t always the same as the number on a savings deposit slip.
This will help ensure that you are paid correctly.
All accounts with the Buffalo Metropolitan Federal Credit Union have to be set up with them and they will forward the paperwork
to us. No changes need to be made if you currently have deductions sent to the Federal Credit Union, and those deductions will
not be changed. Are you a member of the Credit Union YES_______
NO________
Important! Please read and sign before completing and submitting.
I hereby authorize the Buffalo Board of Education (hereinafter “BOE”) to deposit any amounts owed me by initiating the credit
entries to my account at the financial institution (hereinafter “Bank”) indicated on this form. Further, I authorize Bank to accept
and to credit any credit entries indicated by the BOE to my account. In the event that the BOE deposits funds erroneously into
my account, I authorize The BOE to debit my account for an amount not to exceed the original amount of the erroneous credit.
I agree that this authorization will remain in full force and effect until the BOE and the Bank have received written notice from me
of any modification. Any modification will require 3-4 weeks to complete.
:__________
:__ __ ____ ____ __ __ __
__________________________
___________
Date
Employee #
Dept.
Location
Employee Name:_____________________________________________ Employee # ___ ___ ___ ___ ___ ___
(Please Print Name)
Employee Signature:____________________________________________________________________
(PART 1 )
NEW ACCOUNT INFORMATION
(PART 1)
The last item must be for the remaining amount owed to you. To distribute to more accounts, please complete another
form. Make sure to indicate what kind of account, along with amount to be deposited, if less than your total net
paycheck (NO CHECK WILL BE ISSUED TO YOU). If a negative check is created due to excessive deductions the
Payroll Department reserves the right to make the necessary adjustments.
1. Bank Name/City/State:________________________________________________________________________
Routing/Transit #:__________________________________ Account #:________________________________
Checking
Savings
Other
I wish to deposit: $__________________ or Entire Net Amount
2. Bank Name/City/State:________________________________________________________________________
Routing/Transit #:__________________________________ Account #:________________________________
Checking
Savings
Other
I wish to deposit: $__________________ or Entire Net Amount
3. Bank Name/City/State:________________________________________________________________________
Routing/Transit #:__________________________________ Account #:________________________________
Checking
Savings
Other
I wish to deposit: $__________________ or Entire Net Amount