TO:
DELIVER
TO:
FORM LETTER INVOICE RECEIPT
ITEM QUANTITY SUBTOTAL
ZIP +4 PHONE EXT. DATE AMOUNT
DATE
DATE
CITY, STATE, ZIP CODE
DAYTON, OHIO 45469-1640
SUPERVISOR(S)
payment date.
Please review the policies/requirements on the website.
+4 ZIP:
Must be received in Treasurer's Office, St. Mary's 301,
SIGNATURE OF INITIATOR
NOTES:
Depositor Account Number:
UNIVERSITY OF DAYTON
TREASURER'S OFFICE
Type of Account (Checking, Savings, Etc.):
Depositor Account Title:
DESCRIPTION OF ITEM / PURPOSE OF DOMESTIC WIRE TRANSFER
Address of Bank:
Name of Bank:
TOTAL
9 Digit Routing/Transit/ABA#:
ITEM PRICE
Reference:
FORWARD TWO COPIES TO TREASURER'S OFFICE, ST. MARYS 301, (+1640). DEPARTMENT RETAINS ONE COPY.
CONCURRENCE(S)
DOMESTIC WIRE TRANSFER (Federal Funds)
DOMESTIC ELECTRONIC PAYMENT REQUEST FORM
DOMESTIC ACH PAYMENT
(+1640) at least three (3) business days prior to
DOCUMENTATION ATTACHMENT(S)
NAME OF VENDOR
PAYABLE TO:
DELIVERY DATE:
RETURN FORM TO:
TELEPHONE
DEPT. BLDG/ROOM NO. ZIP+4
ADDRESS:
MAILING ADDRESS:
FEDERAL I.D. NO./SOCIAL SECURITY NO.
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