Fillable BRCC foundation AUTHORIZATION FOR DISBURSEMENT

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BRCC foundation AUTHORIZATION FOR DISBURSEMENT

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U.S.A. forms for Baton Rouge Community College

BROWSE BATON ROUGE COMMUNITY COLLEGE FORMS

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AUTHORIZATION FOR DISBURSEMENT
TOTAL:
INSTRUCTIONS: Completed disbursement forms must be submitted to the Baton Rouge Community College Foundation. We are
located at 201 Community College Drive, Governor’s Building, Suite 200, Baton Rouge, LA 70806. ATTACH ORIGINAL RECEIPT, INVOICE
OR SUPPORTING DOCUMENTS
______________________________________________________________ __________________________
Authorized Account Administrator/Vice Chancellor/Chancellor Date
____________________________________________________________________________ ________________________________
BRCC Foundation Date
FOUNDATION USE ONLY:
FOUNDATION CHECK #: ____________ CHECK DATE: ______________ DATE RECEIVED: ________________
RECEIVED BY: ____________________________________________________________________________
DATE
ACCOUNT NAME
ACCOUNT #
PAYEE/VENDOR NAME and ADDRESS
SPECIAL INSTRUCTIONS
Direct to Vendor
Mail Check
Pickup
Other_______________
CONTACT NAME:
TELEPHONE #:
DESCRIPTION/PURPOSE
AMOUNT
SIGNATURE APPROVAL
I CERTIFY THE FOLLOWING: The above expenses incurred are in accordance with the documented
purposes of the fund charged as well as the policies and procedures established by the Baton Rouge
Community College Foundation. None of the above expenses have been paid by any other funding
source. The undersigned acknowledges that the Foundation will rely upon certification made herein
on behalf of the College.
Route to BRCC
Foundation
Attn: Theryl Drew
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BRCC foundation AUTHORIZATION FOR DISBURSEMENT

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Completed 21 January 2020

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