Fillable ASU Disbursement Authorization (Darton State College)

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ASU Disbursement Authorization (Darton State College)

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DISBURSEMENT AUTHORIZATION
TO: Accounts Payable DATE:
West Campus K207
REQUESTER NAME:
DEPARTMENT:
Send one (1) copy to Accounts Payable with supporting documentation.
Per State Accounting Office Policy, a Purchase Order is required for all purchases or obligations to purchase goods and services greater than $2,500, with very limited exceptions.
If this is a Stipend, please check here:
Business Purpose (Clear Description of Payment Request):
PAYABLE TO:
SUPPLIER ADDRESS/PHONE:
SUPPLIER ID (if known):
PURCHASE ORDER NUMBER:
Payment Information
Account Information
Payment
Invoice Number
Invoice Amount
Department Name
Account
Number
Fund
Dept. #
Program
Class
Project
Amount
Special Instructions:
TOTAL
$0.00
As the initial approver, I hereby certify that the above items have been received or the services performed as stated and that the funds are available from the
budgeted account(s) indicated above. I also certify that these expenses are in compliance with established policies and procedures of Albany State University
and that they have not been (nor will not be) reimbursed in duplicate.
Initial Approver: _________________________________________________ Date: ___________________ (Required)
As approver, I hereby certify that I approve the payment of the above transactions and to my knowledge the funds are available to cover the expenses.
Approved By: ___________________________________________________ Date: ___________________ (Required)
Approved By: ___________________________________________________ Date: ___________________ (Optional)
Business Office Use Only
Processed By:
_____ Accounts Payable _____ Other
Audit Check
_____ Approvals _____ Original Invoice
_____ Accounts Correct
_____ Quantities/Prices Correct
_____ Check Copy/ACH Correct
Checked by:
Comments:
Have questions? Email: accountspayable@asurams.edu Fiscal Affairs 4/2018
$ 0.00
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ASU Disbursement Authorization (Darton State College)

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Completed 7 September 2020

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