Request Form

Payment Request Form

Payment Due:

Payment Request Information

Request ID:
Request Creator:
Creation Date:

Vendor Payment Information

Vendor Search:(required)

Simple Search Advanced Search

Request Type Information

Request Type:(required) Invoice Check Request

Invoice Number:(required) Amount: $(required)

Invoice Date:(required) Received Date:(required)

Additional Payment Request Information

PO Number:

Check Notes:

Information required to be printed on Check, such as account number for Utilities.

Additional Handling

Delivery Method: FedEx
Send to 3rd Party
Hold for Pickup
None

Other Handling: Foreign Currency
Separate Check
Include Remittance
Other

FedEx Information

Note: Payment requests with FedEx delivery require an additional four business days after request is approved and payment terms are met.

Recipient Name
and Address:(required) FedEx Project Number:(required)

Signature Requested upon Delivery Saturday Delivery

Send to 3rd Party Information

3rd Party Name
and Address: (required) Phone:(required)

Special
Delivery
Instructions:

Hold for Pickup

Designee for check pickup.

Name:(required) [Select] [Clear] User ID: Phone:

Foreign Currency

Enter three character currency code (e.g., GBP)

Currency Code: (required)

Other

Description:(required)

Payment Request Line Items

Payment Request Items (* = REQUIRED)

Duplicate Delete
	Project Number / Name				Acct ID/ PAA/ Name*	Org Abbr / Name*
	999999.999.999/ ENHANCEMENTS				999-99-000-0000 / 9999 / Staff	9999 / Applications
	Amount*	Percent*	Tax/VAT	Taxability	Notes

Attachments

Attachment Table


Option	Document	Date	Author	Author ID
Delete	Invoice Scan.doc	04/23/2007	JAY ROBINSON	ROBINSONJ
Delete	ACME_Invoice.ppt	05/17/2008	JAMES SMITH	SMITHJA

Comments General Comments:

Payment Request Routing

Approval Chain

The approval chain is based on an invoice amount of $250.00 and project #99999.9.9999.999

Division Approver:

Alternate Approval Routing

The default payment request approvers are determined by the project number or organization abbreviation listed in the first line item. Select alternate routing if a different project number or organization abbreviation should determine the payment request approvers.

Alternate Routing: Use Alternate Approval Routing

Routing Options

Route:(required) For Approval For Ad Hoc Review