Fillable Payment Request Form printable pdf download

Payment Request Form

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PAYMENT REQUEST FORM

This completed Payment Request Form (PRF) is for registration and lodging only and must be

attached to the original approved Travel Authorization Request Form for each person, along with

the appropriate completed conference/meeting registration form and/or lodging reservation

confirmation.

Conference/meeting registration fees and lodging can be paid by the college by completing this

form. If requesting both [Registration and Lodging], then two separate requests are needed.

Please complete all fields on this form to prevent a delay in check processing. Once the

completed and approved forms reach the Business Services office, please allow 7-10 business

days for check preparation and mailing, as checks are printed every Tuesday and Thursday.

Name of Faculty/Staff/Student: ________________________________________________________

Department Number: _________________

Department Name: ___________________________

(Dept. # to be charged)

CHECK PAYABLE TO:

Payee Name: __________________________________________________________________

Payee’s TIN: _________________________________

Federal Tax ID

SSN

(If a business, attach completed W-9 Form )

Mailing Address: _______________________________________________________________

City: _________________________ State: ____________ Zip Code: _____________

Payee Amount: $ _________________

Comments: ____________________________________________________________________

For Registration:

All checks will be mailed, unless special arrangements are made in advance.

For Lodging: E

mployee will be responsible for picking up their check 1-3 days prior to trip.

If have any questions, please contact Pam Lane 706-272-2565.

===========================================================================

ACCOUNTING OFFICE USE ONLY: Chartfield Combination

Account - Fund - Department -

Program -

Class - Project/Grant

Invoice # _________________

Voucher # __________________

Entered By _______________

Payment Request Form

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