Direct Invoice / Credit Memo Form
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1Clear Form
Department of Finance and Administration
Office of Accounting
Print
Direct Invoice / Credit Memo - Form F10001
Submit by E-mail
BASIC DATA
REMIT TO:
Vendor No:
Invoice Date:
Payee:
Transaction:
Posting Date:
Address:
Reference:
Invoice Amount:
City:
Calculate Tax:
Yes
No
State:
ZIP Code:
TAX AND WITHOLDING
DETAILS
Tax Code:
Withholding Code:
Assignment (Invoice #):
Business Area:
ONE TIME VENDOR DATA
PAYMENT DATA
Name:
Payment Terms:
Address:
Payment Method:
Payment Method Supplement:
City:
State:
ZIP:
House Bank:
Cont. Key (CK/SAV):
Tax ID:
Payment Block:
Bank Key (Rtg. No.):
Payment Reference:
Bank Account:
Invoice Reference:
MANUAL CHECK ONLY
DETAILS
Check Number:
Cash GL Account:
Check Date:
Check Amount:
EXPENSE DETAIL
Line No.
GL Account
Amount
Tax Code
Cost Center
WBS Element
Internal Order
Earmarked Funds
Text
1
2
3
4
5
TOTAL
$ 0.00
Date:
CHECK BOX IF 2ND PAGE USED
(R 02/19/2014 by TNLEITMEYER)
Signature:
Page
Out Of
DFA Accounting Only
Remit Form to:
Office of Accounting Service Bureau, PO Box 3278, 1509 West 7th, Room 100, Little Rock, AR 72203
Invoice Document Number:
E-Mail: SB-ACCOUNTING@DFA.STATE.AR.US | Telephone: (501) 682-1675 | Fax: (501) 682-2166
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Parent category: Business