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 _______________