DISTRICT ACCOUNTS PAYABLE OFFICE
DIRECT PAY REQUEST
(DO NOT USE FOR MILEAGE, TRAVEL, OR
PROFESSIONAL SERVICES)
Please refer to Delegations of Purchasing and Contracting Authority at: http://purchasing.fhda.edu/policies
BANNER ID:
BANNER INV:
For Accounting Use Only
Requested by:
Approved by:
First & Last Name (Please Print)
(Please Print) (Please Print)
First & Last Name (Please Print)
EMPLOYEE Signature (Required)
APPROVER Signature (Required)
DateExtension
DateExtension
PLEASE LIST THE INVOICES BELOW: (PROVIDE COMPLETE EXPLANATION AND ATTACH ORIGINAL RECEIPTS)
Date of Request Date Check Required
Make Check Payable To: Remit To Address:
Your Reference #
(Optional)
TOTAL:
AMOUNTFUND (6 digits)INDEX (6 digits)
Required:
ORG (6 digits) ACCT (4 digits) PROG (6 digits)
Revised 06/30/11
