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1. What type of payment(s) does your department plan to accept? Check all that apply.
Cash
Check
Credit Card
2. How often will your department accept the payment method(s) above?
Is this for a one-time or ongoing event?
3. How will your department accept these payments?
Check all that apply.
Mail
Phone
In Person
Online
4. Describe the reason for accepting payments and the business need that exists within your department.
(An approved list of fees for services rendered must accompany this request.)
5. What Budget Unit will payments be deposited to? List all applicable budget units below.
Check the box if payments are being deposited to a grant or project.
List grant/project number to the right.
6. Indicate all persons who will be handling or collecting cash, preparing and/or
delivering deposits
Name:
Name:
Name:
Title:
Title:
Title:
All employees handling cash, as defined in the Departmental Revenue Collection Policy, must complete the Cash Handling Training. Contact the Controller's
Office for additional information. A minimum of 2 people is required.
Deliver
Prepare
Collect
Ongoing Event
Credit Card Registration Form
7. To accept online registration and online credit card payments, complete and attach the following form.
Department Name:
8. Requesting Department Contact Information
Signature
Budget Unit Number:
Box Number:
Budget Unit Head:
Date
Controller's Office Use Only
Approved
Declined
Vice President: (Departmental)
Signature
Date
Controller:
Signature
Date
Vice President of Finance:
Signature
Date
Requested By:
Signature
Date
Department Head/Director:
Signature Date
Dean:
Signature
Date
Collect
Title:
Title:
Title:
Title:
Title:
Deliver
Prepare
Name:
Name:
Name:
6. Continued
A
ll employees handling cash, as defined in the Departmental Revenue Collection Policy, must complete the Cash Handling Training. Contact the Controller's
Office for additional information. A minimum of 2 people is required.
Name: