SECTION I:
First
Middle Last
Street Address City State Zip
Must choose one of the circles below:
BMC ID :
Name of Payee:
Payee’s Address:
Travelers:
Same
as payee
Other (indicate name)
Nonresident alien (country)
:
(A
ppropriate signed Glacier forms must be attached)
Reimbursement
SECTION II:
SECTION III: Certification and Authorization
We certify the following:
1. The reported expenditures were incurred in connection with College business.
2. No portion of the claimed expenses has been or will be reimbursed from other sources.
3. Expenses adhere to the College's policies and guidelines.
4. Expenses are substantiated by the attached original itemized receipts which indicate method and amount of payment.
Exceptions to the policy, such as lack of original itemized receipts, have been approved for the following reason(s) below:
Form Completed By:
Payee's Signature:
(Required for Employees)
Authorizing Signature:
Phone ext.
Today's date
E
mployee
Student-Mailbox #:
Business Purpose Expense(s) Description:
Date(s) of Expense(s) or if Travel, Date Range:
Travel: City, State or Country:
(Must Complete BMC Travel Expense Summary)
ORIGINAL ITEMIZED PAID RECEIPTS/INVOICES FOR ALL EXPENSES MUST ACCOMPANY THIS REQUEST.
If travel, attach BMC Travel Expense Summary When receipts are not available, please use Section III and include
the reason for the missing receipts. See page 2 for payment to a foreign vendor.
Pick up Check
Citizenship
(Honorarium Only)
:
U.S. or resident alien
(W-9 must be attached or on file)
Honorarium
(Account code 51814)
Other
AMOUNT
Project
TOTAL AMOUNT:
Expense
Department
16 DIGIT ACCOUNT NUMBER
Fund
Foreign Wire Request
(Foreign Currency Only)
Advance Reporting
(Due 30 days after expense)
Advance:$200 minimum
(B
MC Employee/Student Only)
Campus Mail (dept name/bldg):________________________
Phone ext.
Today's date
US Mail to Payee's Address
Employees (Faculty, Staff or Students) are paid by Direct Deposit to same bank account they chose for their paycheck.
Non-Employees (Guests or Students not employed by BMC) are paid based on the default method in their vendor record.
Mail check or notice of deposit to:
Phone ext.
Today's date
Instructions: Open form and save as PDF, complete form electronically
(Recommended),
print, attach required
documents, obtain required
signatures.
Send to Controllers Office, Accounts Payable-Cartref Hall
.
BRYN MAWR COLLEGE
Payment Request (Non E-Market)
Must select one or more boxes:
