Please return this form with all receipts to Accounts Receivable, Room 201 Jardine Hall.
Revised Date: 02/14/2017
Safekeeping Check Request
Accounts Receivable Department (316) 978-3333
Date:
All information must be completed.
Payee/Vendor Name :
myWSU ID: Check mailed to payee: Yes
No
WSU ID is required. W-9 or W-8 BEN form will be required for all new WSU IDs.
Address:
Street
City State Zip
Description of Charges:
Must attach documents. Failure to do so will delay processing.
Safekeeping Name: Box #:
Complete name of organization
Requestor’s Name: Phone #:
If student is requesting the check, please sign here
Sponsor’s Signature: Phone #
:
Required signature of sponsor/budget officer
Please note processing details (AR will complete):
_____ Amount was increased to include sales tax _____ Payee receiving funds via direct deposit
_____ Payee will be sent a 1099 _____ Check is enclosed mailed
_____ Department received funds electronically _____ Applied to payee’s account
WSU Accounts Receivable Use Only
Account Balance (FGIBAVL): $______________________ AR Initials: ________ AR Initials: ________
WSU Accounts Payable Use Only
EXPAGY EXPSVC Reportable Expense 1099
Check #:
AP Approved By: Issue Date:
Banner Fund Banner Organization Amount
$
Safekeeping
Account to
be charged
