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BANNER DIRECT PAYMENT REQUEST FORM

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BANNER DIRECT PAYMENT REQUEST FORM
BANNER DIRECT PAYMENT REQUEST FORM
Use this form to request special payment that do not fall under the category of a Purchase Order and/or the Reimbursement Request Form.
Original invoices, receipts or other supporting documentation must be provided with this form. Incomplete forms will be returned.
PAYEE INFORMATION
1. Type of Payee:
Non-Employee (Individual)
Business
2. Banner Vendor ID #:
3. Full Business Name or Payee name (First Name, Middle Initial, Last Name)
4. Address (Street Address, City, State, Zip Code)
5. Special Delivery Instructions: (extraordinary circumstances only)
6. If new vendor please attach a completed and signed W-9 (put AP link here)
EXPENSE AND ACCOUNT DETAILS (ALL FIELDS ARE REQUIRED)
Description
Amount
SELECT
Index OR Fund
Account Number
TOTAL
ALL FIELDS ARE REQUIRED
Requestor Name (print)
Signature
Telephone / E‐mail address
Date
Department Name/Room#
Approver/Administrator (print)
Signature
Telephone/Ext.
Date
Approver/Administrator (print)
Signature
Telephone/Ext.
Date
Send Completed Forms To:
Accounts Payable - Belfer 111-Resnick Campus
FOR ACCOUNTS PAYABLE USE:
APPROVER INITIALS: _______________
DATE: ______________
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