Direct Payment Request Form
In order to process your request, form must be properly completed, signed, funds available
and attach approved invoice. Once ready for processing, please drop off to: FISCAL
SERVICES - Building C - Room 203. If you have questions about the process, please call (626)
585-7451.
Banner Invoice
Vendor #
(For Accounts Payable Use Only)
Vendor
Address
City
State
Zip
Board Report Date:
Consent Item Number:
Description/Comment:
Invoice Date Invoice Number Invoice Amount
Fund Org Account
Prog
Amount
Autorized Signatures
Cost Manager Today's Date
Jan-18
Budget Administrator Today's Date