Fillable Payment Or Reimbursement Form

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Payment Or Reimbursement Form

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The Payment Or Reimbursement Form form is 1 page long and contains:

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  • 5 check-boxes
  • 21 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California State University, Fresno

BROWSE CALIFORNIA STATE UNIVERSITY, FRESNO FORMS

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Chapter and Club
Payment or Reimbursement Form
Fresno State Alumni Association | www.fresnostatealumni.com | Phone: 559.278.ALUM | Fax: 559.278.6790
Chapter or Club Name:
____________________________________________________________
Instructions:
1. Complete one form for each payment or reimbursement you are requesting.
2. Requests must be completed and turned into the FSAA no later than 15 days of the date of the
invoice/purchase to allow for an accurate monthly budget report.
3. Original invoices and/or receipts must be provided with the completed form (can be mailed or delivered).
4. The individual receiving reimbursement may prepare the form and may sign as the “Preparer”, but they
may not be one of the individuals approving payment. An individual may not prepare and sign their own
reimbursement form.
5. For any reimbursement or payment over $250, two “Approved signers” signatures are required.
6. “Approved” signers must be those officers listed as Authorized Signers on the chapter/clubs account.
Is this a:
[Payment to a person] Reimbursement for an expense already incurred
[Payment to a vendor] Payment on an invoice
[Payment to a campus department/program/unit] Payment/transfer of funds to an on-campus entity
PAYMENT INFORMATION
Vendor/Person name:
______________________________________________________________________
Mailing address:
______________________________________________________________________
City:
_______________________________
________
Zip:
____________
If an invoice:
Invoice #:
_____________
Amount:
$______________
Date:
____________
HOW WOULD YOU LIKE TO RECEIVE PAYMENT?
U.S. mail
Pick up at the Fresno State Alumni Association office
Person picking up check:
________________________________________________
Cell phone (required):
________________________________________________
EXPLANATION OF COST
Event:
______________________________________________________________________
Location:
___________________________________________
_________________
Purpose of cost:
ACCOUNT SIGNER AUTHORIZATION
Prepared by (print name):
___________________________________________
Date:
__________________
Approved signer #1
Print name:
___________________________________________________________
Signature:
________________________________
Date:
__________________
Approved signer #2
Print name:
___________________________________________________________
Signature:
________________________________
Date:
__________________
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Payment Or Reimbursement Form

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Completed 3 May 2020

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