Fillable As541 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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As541 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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Louisiana State University
Office of Accounting Services
Accounts Payable & Travel
217 Thomas Boyd Hall
REQUEST FOR DIRECT DEPOSIT OF EMPLOYEE REIMBURSEMENT AS541
Request Date ________________
Department
Contact
Phone Fax E-mail
Payee
Employee or
Student *If student, please check below:
LSU ID ___ Undergraduate
Document # ___ Graduate
___ Ph.D.
APPROVALS Signature Printed Name Date
I certify that the above goods have been received and that this bill is properly reimbursable.
I understand that itemized receipts must be provided in order to be reimbursed for the purchase(s). I also understand that since I paid with
personal funds, I will NOT be reimbursed sales tax by the University.
Employee’s Signature
Supervisor Approval*
Authorizing Signature
*Supervisor Approval or departmental person with first-hand knowledge must approve to substantiate the validity of the purchase
Description Quantity Unit Unit Price Total Price
Total Due to Employee
Account #
I do I do not have a University procurement card.
Transaction Type
Purpose of Purchase:
Object Code
Sub Object Code
Project #
Amount
Rev 4/15
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As541 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 15 November 2019

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