Student Activity Fund Office - Check Request Addendum Form

STUDENT ACTIVITY FUND OFFICE - CHECK REQUEST ADDENDUM

Page ______ of ______

Organization Name: ___________________________________________

Account No.: _____ _____ _____ _____ Date: _________________

PAYMENT LINE ITEM DETAIL:

Invoice #: ________________ Description: _________________________________________________________________ Amount: __________________

Fund Code: _____ _____ Expense Code: _____ _____ _____ _____ Account#: _____ _____ _____ _____ * Withhold 4% NC Tax?

YES / NO

Invoice #: ________________ Description: _________________________________________________________________ Amount: __________________

Fund Code: _____ _____ Expense Code: _____ _____ _____ _____ Account#: _____ _____ _____ _____ * Withhold 4% NC Tax?

YES / NO

Invoice #: ________________ Description: _________________________________________________________________ Amount: __________________

Fund Code: _____ _____ Expense Code: _____ _____ _____ _____ Account#: _____ _____ _____ _____ * Withhold 4% NC Tax?

YES / NO

Invoice #: ________________ Description: _________________________________________________________________ Amount: __________________

Fund Code: _____ _____ Expense Code: _____ _____ _____ _____ Account#: _____ _____ _____ _____ * Withhold 4% NC Tax?

YES / NO

Invoice #: ________________ Description: _________________________________________________________________ Amount: __________________

Fund Code: _____ _____ Expense Code: _____ _____ _____ _____ Account#: _____ _____ _____ _____ * Withhold 4% NC Tax?

YES / NO

* NC 4% Withholding for Nonresident vendors - NC law requires that NC income tax be withheld from payments made to nonresidents for personal services if the annual (calendar year) amount to be paid

to an applicable vendor exceeds or is expected to exceed $1,500.

Please complete the section on the back of this form for student congress allocations. All Student Congress allocations not used by the end of the academic year is subject to Title V. No funds of an officially

recognized student group administered through the SAFO may be used to purchase alcohol. Please refer to for more information.

_______________________________________________

_____________________________________________

Print name / Authorized Advisor, Treasurer or President

SAFO Employee (PRINT)

________________________________________________

_____________________________________________

Signature / Authorized Advisor, Treasurer or President

:

SAFO Employee Signature

(Revised 2/19/2016)