INVOICE
FROM:
(Name)
(Address)
(City, State, Zip)
(FEIN or SSN)
TO:
Fairmont State University
1201 Locust Avenue
Fairmont, WV 26554
INVOICE #
DATE
__________________________________________________________________________________________________________
Description
Payment is requested in the amount of: $
For services rendered to Fairmont State University from:
Beginning Date of Service:
Ending Date of Service:
Description of Services Provided:
Vendor’s Signature:
Department Approval:
Accounts Payable Approval:
I hereby certify that the above vendor has completed
his/her indicated service during the dates indicated and
authorize payment from the following account:
Fund__________ Org__________ Account__________
Travel Expenses to be reimbursed?
Yes No
PO/AGREEMENT #
Signature:
Date
Revised 3/1/2020
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