Description and Reason for Purchase
Invoice Number
Amount
Total Amount
Invoices submitted for payments not in accordance with University polices will be considered a personal expense for the individual placing the order with the
vendor and will not be paid.
Original invoice must be attached to this form. If you only have a statement, please contact the vendor and obtain an invoice.
* Whenever possible, employees are encouraged to use the University Purchasing Card.
* This form is only to be used if the department has received the merchandise and payment needs to be made.
Valid for purchases of $5,000 and under, which will not accept the University Payment Card and are not recurring.
* Does not apply to "X" funds.
Fund
Code
Orgn
Code
Account
Code
Activity
Code
Authorized Signature:
Department:
Department Address:
Accounting Signature:
Date:
Contact Person:
Contact Phone:
Date:
Please fill out ALL information and submit to the Accounts Payable Department for approval.
If you have any questions, please call 734-487-0022 for assistance.
Vendor Name:
Street Address:
Phone:
City:
Fax Number:
State/Zip Code:
Direct Pay
Total Amount
Split
Amount
Smart or Eagle ID:
Invoice Date
Authorized Printed Name:
Authorized Signature:
Authorized Printed Name:
Student Organizations (X funds) require two authorized signatures.
Print
Reset