Invoice Request For Auxiliaries Form - University Accounts Receivable
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1University Accounts Receivable
INVOICE REQUEST FOR AUXILIARY
University Hall 360 - Phone: (818) 677-3474 - Fax: (818) 677-2840 - Mail Code: 8334
Department Name:______________________________________Request Date:_________________Date of Service:__________________*
*If the date of request is greater than 30 days of the date the service was provided, a justification is required with approval by the AVP of Financial Services.
I.BRIEF DESCRIPTION OF SERVICES PROVIDED:____________________________________________________________________________
Backup information and documentation is required; e.g. paid invoices, salary/benefits records, analyses, schedules of services provided.
II.NAME OF DEPARTMENT RECEIVING REVENUE:__________________________________________________________________________
Required Chartfields (salary, benefits and/or expenses):
Requisition No:_____________________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
0.00
Total Amount:$___________
Financial Approver:______________________________________Print Name:_________________________________Date:____________
Department Contact:____________________Ext:_________Fax:_________Email:_____________________________Mail Code:_________
III.NAME OF AUXILIARY TO BE BILLED:__________________________________________________________________________________
Required Chartfields:
Auxiliary PO No:_____________________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
Account:__________Fund:________Dept ID:________Program:________Class:_______Project:_________________Amount:$___________
0.00
Total Amount:$___________
Fund/Project Authorized Signature:_________________________________Print Name:_________________________Date:____________
Fund/Project Authorized Signature:_________________________________Print Name:_________________________Date:____________
Department Contact:____________________Ext:_________Fax:_________Email:_____________________________Mail Code:_________
Auxiliary Approver:__________________________________Print Name:_____________________________________Date:____________
~UNIVERSITY ACCOUNTS RECEIVABLE DEPARTMENT USE ONLY~
Date Received:____________By:____________________________________Invoice No:___________________Invoice Date:____________
REV: 2/24/16
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Parent category: Financial