Louisiana State University
Office of Accounting Services
Accounts Payable & Travel
217 Thomas Boyd Hall
UNIVERSITY-PREPARED VENDOR INVOICE AS116
Third Party documentation MUST be attached to this form to support the payment.
Request Date __________________________
***Fiscal Year End Accrual
Yes No
Department
Contact
Phone Fax E-mail
Supplier
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.
Total Due to Supplier
Justification: Government does not prepare invoices
Other ________________________________________________________________________________
Supplier #
Document #
PO Yes No
If Yes, PO #
Sales Tax
Freight
Usage Tax
Additional Cost
Document Total
Amount
Spend Category
Program
Project
Gift
Grant
Cost Center
Fund
Function
Additional Worktags
REQUIRED FOR DIRECT CHARGE INVOICES ONLY:
I certify the attached invoice adheres to PRO-U525.A, Exceptions to the Competitive Solicitation Process and will be processed
as a Direct Charge payment.
Authorized Signature
Rev 7/19
