Procurement and Contract Services
P.O. Box 425439 / Bralley Annex Denton, TX 76204-5439 P: (940) 898-3812 F: (940) 898-3519 ● procure@twu.edu
Rev: 1/19
Request for Approval and Payment of Membership and Dues
Check list of approved memberships here.
MEMBERSHIP INFORMATION
Date: Membership Renewal Period: 1 yr from to
2 yr from to
3 yr from to
Vendor Name Vendor FID#
Vendor Address:
Purpose and benefit to TWU:
Type of Membership: Institutional Individual
Amount to be Paid: $
DEPARTMENT INFORMATION
Department or Individual Requesting Membership
7201
Account to be Charged Amount
7201
Account to be Charged Amount
Note: Attach all supporting documentation relevant to this membership.
APPROVALS
Printed Name of Account Manager Signature of Account Manager Date
Printed Name of Vice President or Provost Signature of Vice President or Provost Date
Signature of V.P. of Finance & Administration
Date
Signature of Other approvals as required
Date
Printed Name of V.P. of Finance & Administration
Printed Name of Other approvals as required
Jason Tomlinson
To be paid by: Check or PCard