| 1) Account Number |
Enter your complete account number (example: 60-5945-6110-0000). |
| 2) Amount |
Enter the total dollar amount of all items listed on the form. |
| 3) Dept. name |
Enter the name of the requesting department. |
| 4) Date |
Enter the date the Request for Payment is prepared. |
| 5) Initiated By |
Enter the name of the person completing the requisition. |
| 6) Ext. |
Enter the phone number of the person who can answer questions about
the Request for Payment in case clarification is required. |
| 7) Need Check By |
Enter the date when payment is needed. |
| 8) Payee |
Provide the complete name and address of the individual or firm who
is to receive payment. |
| 9) Soc. Security # or Invoice # |
If payment is to be made as the result of an invoice, enter the
invoice number. If payment is to be made to an individual, enter
the social security number. |
| 10) Complete Description |
Enter a complete description of the items for which payment is to be
made. |
| 11) Amount |
Enter the total amount of the attached receipts. |
| 12) Initiator |
Must be signed by the person completing the Request for Payment. |
| 13) Director/Chairperson |
Must be approved by one who has budgetary responsibility (i.e.,
president, vice president, dean, director, chair, etc.) |
| 14) President/Vice President |
It is not necessary to use this line unless the person who has
budgetary responsibility is the president or vice president. |
| 15) Controller |
This line is for Business Office use only. Please leave it
blank. |
