Rev 2/17
Louisiana State University
Office of Accounting Services
Accounts Payable & Travel
217 Thomas Boyd Hall
EXPENSE REIMBURSEMENT FOR NON-WORKERS AS541-NW
Request Date ________________
Department
Contact
Phone Fax E-mail
Payee
Address
Supplier ID City
Document # State
Zip
Description Quantity Unit Unit Price Total Price
Total Due to Non-Worker
Spend Category
I do I do not have a University procurement card.
Program
Purpose of Purchase:
Project
Gift
Grant
Cost Center
Fund
Function
Additional Worktags
Amount