Fillable As02 L O U I S I A N A S T A T E U N I V E R S I T Y

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As02 L O U I S I A N A S T A T E U N I V E R S I T Y

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U.S.A. forms for Louisiana State University

BROWSE LOUISIANA STATE UNIVERSITY FORMS

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Rev 4/14
Louisiana State University
Office of Accounting Services
Accounts Payable & Travel
217 Thomas Boyd Hall
MISCELLANEOUS CHECK REQUEST AS02
This form should be used to request payments for refunds or payments charged to revenue or liability accounts.
Third Party Documentation MUST be attached.
Request Date __________________________
Department
Contact
Phone
Fax
E-mail
Trans
Type
Object Code
Sub Object Code
Project #
DR/CR
Amount
Purpose of Payment ____________________________________________________________________________
Approved by
_____________________________________ ________________________________ ____________________
Authorizing Signature Printed Name Date
Vendor # or
LSU ID
Document #
Doc Type
MC
Payee
Address
City
State
Zip
U.S. Citizen
Yes No If no, citizen of ______________
Green card holder/
resident alien
Yes No If yes, a copy of the card must be attached.
Sales Tax
Freight
Additional Cost
Document Total
Document Date
LSU Employee
Yes No
Separate Check
Yes No
Due Date
Remit Message
(limited to 60 characters)
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As02 L O U I S I A N A S T A T E U N I V E R S I T Y

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Completed 14 February 2020

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