Fillable Authorization for Billing (Mat-Su College)

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Authorization for Billing (Mat-Su College)

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Attn: Cashiering
8295 E College Dr
Palmer AK 99645
Phone: 907-745-9739
Fax: 907-745-9711
Email: msc.campus.cache@alaska.edu
Authorization for Billing
THIS IS NOT AN INVOICE
The following can be billed for services rendered. Please charge expenses to our
agency/company as described below:
Agency/Company Information
Please enter the Agency/Co
Name:
mpany Name
Billing/Mailing Address:
Email Address:
Billing Contact Name:
Contact Phone Number:
Students/Items Authorized for Billing
This can include but is not limited to: tuition, course fees, testing fees, textbooks and supplies.
University
Student ID#
Name of Student
Items Authorized
Amount
not to exceed
$
$
$
$
$
$
$
$
$
$
Total Amount Authorized to Bill:
$
Signature Printed Name Date
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Authorization for Billing (Mat-Su College)

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Completed 30 January 2021

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