FORM 1
SUPPORTING DOCUMENTATION MUST BE ATTACHED
Complete entire form
ADDITIONAL INSTRUCTIONS ON REVERSE SIDE
PLEASE DIRECT ALL QUESTIONS CONCERNING THIS FORM TO 588-6413
ISSUE CHECK TO: DISPOSITION INSTRUCTIONS: (Check One)
NAME: E-CHECK __________(mandatory for employees and students.)
SOC. SEC. NO.: MAIL CHECK _________
W-9 COMPLETED/ON FILE ______________________
PICKUP at Student Accounts ______
ADDRESS:
SERVICE PERFORMED:
DATE(S) OF SERVICE:
FEE FOR SERVICE:
REIMBURSABLE EXPENSES:
TOTAL CHECK AMOUNT:
Last updated 2/7/17
ACCOUNT NUMBER
AMOUNT
____--____________--________
____--____________--________
TOTAL CHECK AMOUNT
NON-EMPLOYEE COMPENSATION
CHECK REQUEST
Payment to a person or non-incorporated business for a service-
performer, lecturer, speaker, presenter, wait staff, honorarium,
stipend, grant
REQUIRED FOR PAYMENT
DEPT. NAME:
REQUESTOR:
SIGNATURE:
PRINT NAME: __________________
PHONE EXT:
DATE: ________________________
APPROVED BY:
SIGNATURE:
PRINT NAME:
DATE:
SIGNATURE:____________________________________________________
0.00
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WHEN TO USE THIS FORM:
The Check Request Form 1 is used to process all payments that must be reported to the IRS on Form 1099. These
include payments for consulting, professional and fee-based services. Payment to any unincorporated vendor should
be submitted on a Check Request Form 1. Honoraria should also be processed on Form 1.
WHEN NOT TO USE THIS FORM;
Approved invoices (those with a vendor invoice number, an account number, and an approving authorized
signature on them) from incorporated vendors should be sent directly to Accounts Payable for payment processing
without any Check Request form.
Reimbursements to employees and service providers for miscellaneous expenses, local travel and meals should
be processed on Check Request Form 2. Reimbursement requests must include appropriate receipts and
supporting documentation.
Form 2 is also used to request payment for mail order items and subscriptions and to prepay hotel and conference
expenses.
Employees of the University cannot be paid for services on Check Request forms. These requests must be
processed through the Payroll Office.
INSTRUCTIONS FOR USE:
A completed IRS Form W-9 must be on file in the Accounts Payable Office for tax identification purposes before
any payment can be made. If this is the first time this calendar year that this person has been paid, please include
the appropriate IRS form with the request for payment. Blank W-9 Forms are available on the same page as this
form is found.
The original invoice or supporting documentation should be attached. This documentation is required in addition
to the description of service written on the form. If an original invoice is not available, a memo of explanation
providing a description of the goods or services received is required. An authorized signer for the department
must approve the memo.
If this payment includes reimbursement for expenses, original receipts must be attached. If the original receipts
are not included, the reimbursement amount will be treated as a taxable payment (i.e. reported to the IRS Form
1099).
Receipts that are not letter size must be taped to a white sheet of paper (8 ½ x 11). Several receipts may be
taped to each sheet of paper (one side only). This process will significantly improve the review of receipts and will
assist in eliminating lost receipts. Please do not overlap receipts or turn vertically on the paper.
If you would like a remittance copy of the invoice or other enclosures included with the payment, please enclose a
copy for this purpose.
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