RequesttoInvoice
LastRevision:10/23/2009
PleasefilloutallinformationandsubmittotheGeneralAccountingDepartment(212Hover)for
processing.Ifyouhaveanyquestions,pleasecall7344871321forassistance.
Copiesofsupportdocuments(PO,contract,application,etc)mustbeattached.
Note:Onlylimitedinformationcanbeprovidedoninvoice.
ItissuggestedyouincludeaStatementofServices/Goods,whichwillbeincludedwiththeinvoice.
CompanyName:
StreetAddress:
(addressinvoicetobemailedto)
City:
State:
ZipCode:
ContactName:
ContactPhoneNumber:
ContactEmail:
InvoiceDetails:
Fund
Code:
Orgn
Code:
Acct
Code:
Amount:
DepartmentContact: Department: DepartmentAddress: DepartmentPhone:
Authorizedby(Print):
AuthorizedSignature:
Pleaseindicatesource
ofmoney:
Federal
N
on-Federa
l
Date:
ForwardOriginal
Invoiceto:
Vendor
Department (department will forward invoice to vendor)
Note:IfDepartmentwillsendinvoicetoVendor,DepartmentmustsendOriginalInvoiceprovidedbyAccounting
SpecialInstructions:
GENERALACCOUNTINGUSEONLY
Date
Received:
Received
By:
Detail
Code:
Invoice
Number:
Dateof
Invoice:
Input
by:
Date
Mailed: