Date
Return Routing Instructions:
_________Needs original or itemized receipt
_________Needs Business Purpose
_________Needs Signatures Doc#
_________Need Invoice
_________Other_______________________________
Please fill out ALL information and submit to the Accounts Payable Office for processing.
If you have any questions, please call 282-2511 for assistance.
Vendor Information:
Payee: __________________________________________________________________________________
Address: __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
City: ___________________________________________________________ State:
Country: ______________________ Zip: Telephone Number: _____________________
The University requires W9 Tax Information on file in the Accounts Payable Office before payments are issued.
Vendor Type:
________ Faculty/Staff ___________Student _________Other _______ Non-Resident Alien
Type of Payment (Check the one t
hat applies and attach related documentation)
_________Participant Award St
ipend
_________Scholarship/
Stipend/Award/Fellowship for Students
_______ Reimburse Employee
_______ Moving Reimbursement
_______ Recruitment
_______ Speaker/Entertainer/Artist<=3000
_______ Subscription/Membership/Dues
_________Research Subject Partici
pation Payment
_________Refunds
_________Other-Specify_________________________________
Accounting Information
Invoice date Invoice # Index Account Code Amount
1
2
3
4
5
Signatures
Contact Person/Prepared By Requesting Department
Signature of Account Director/PI Print Name of Approval/Authorized
Each signature (payee,departmental approval, etc) will be interpreted as certification that all expenditures are valid with respect to business purpose, were authorized
in advance to the ex
tent possible, reasonable in amount, and have been documented as defined in our Manuals of Administrative Policies and Procedures.
Finance and Administration Approval and Routing Use Only
Accounting _____________________ Grant Accounting ___________________
Original Invoice must be attached to this form. If you only have a statement, please contact the vendor and obtain an invoice.
Date
Total
Phone #
Signature of UBO P
rinted Name of UB
O
Date
AP Use Only
_____________________
* Campus Address for Employees of the Universit
EPLS
Activity Code
Business Purpose/Reason for Payment: ______________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
_________________________________________
