[ASB]
Office of Administrative Services
Disbursement Request Form R____-_____
OFFICE OF ADMINISTRATIVE SERVICES USE ONLY
Reviewed:
Verified:
Approved:
Administrative Services
Administrative Services Officer
VP, Administrative Services
Disbursement:
Check
Check Number:
Date:
Please allow 10 business days for processing. Advances must be closed within 14 days of the event.
Default Check Disposition: Employees campus mailbox | Vendors requestor | Clubs Student Life Office.
TR 4/6/20
Student/Employee W#:
Check Payable To:
Address:
City, State, Zip:
Type: Reimbursement | Direct-Pay | Advance
Club Name
Description (Summarize purpose of request. Itemize only when reasonable.)
Amount
Applicable Fiscal Year Check Total
FOAP to be Charged
%
Amount
-
-
-
FUND
ORG
ACCOUNT
PROGRAM
-
-
-
FUND
ORG
ACCOUNT
PROGRAM
Check Disposition: Mail to Address Above | Campus Mailbox | To Requestor | ______________
Date Required: Return Copy to:
Club Officer (signature)
Date
Student Life Director (signature)
Date
Club Advisor (signature)
Date
Vice President, Student Services (signature)
Date
(Wait 5-10s)
$ 0.00
39330
690200
100
39330
690200
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