Club Account Payment Request

PAYMENT INFORMATION
(1)	Vendor Name:
(2)	Vendor Number (if known):
(3)	Mailing Address:
	City, State and Zip:
	Phone Number(s):
	Email Address:

(4) Invoice #

Enter Date(s) of purchase or service:

(5) TYPE OF PAYMENT (CHECK ONE)
a) Reimbursement	d) Cash Award, Scholarship or Gift
b) Products (not for resale)	e) Personal or Professional Services
c) Products for resale	f) Rental

(6) TOTAL AMOUNT REQUESTED: $

(7) ACCOUNT ASSIGNMENT
	$ Amount	GL Account (6 characters)	Club Account Number	Club Name
(a)
(b)
(c )
(d)
(e)

(8) PURPOSE OF PAYMENT: Describe who, what, why, where, when:

(9) Comments (office use only)

(10) REQUIRED APPROVALS: (Must be Advisor and one Officer)
Advisor Name (Printed)		Email:
Advisor Signature:	Date:		Phone Number

Officer Name (Printed)		Email:
Officer Signature:	Date:		Phone Number

I. General Instructions:

(1) Complete all information in pen or complete form online using fillable PDF form. Any changes must be initialed by both signatures on this form, including any errors corrected using correction tape.

(2) This form must be used to request one of the following: a) reimbursement to an individual for a purchase of products or for travel expenses, b) payment to a vendor for products, c) payment to a vendor for custom printed products, d) payment to an individual for an award, scholarship or gift, e) payment to a vendor for services, or f) payment to a vendor for rental fees, such as for meeting space, equipment, boats or lake fees, etc.

(3) Vendors must complete a Vendor Maintenance Request form. If the vendor has already completed a Vendor Maintenance Request form, obtain their vendor number from the vendor list provided on the website, or leave the vendor number blank.

(4) Reimbursements for paying a third party for services are not allowed.

(5) If you are paying someone who is not a U.S. Citizen or permanent resident, contact the University Tax Specialist – 512-245-8708.

(6) Note that all payments by check will be mailed to the address specified.

(7) Beginning January 1, 2010, the vendor may enroll in the university’s direct deposit payment program.

(8) Completed form must be forwarded, with expenditure documentation, to the appropriate business office.

(9) Allow at least 5 to 7 business days, excluding the day of request, for the check to be prepared and mailed.

(10) Effective January 1, 2010, itemized receipts and/or invoices must be attached to this payment request before it can be processed.

II. Specific Instructions (* = Required Field):

PAYMENT INFORMATION:

* (1) Vendor Name: Enter the name of the person or company that you want to pay. This is the name that will appear on the check. For reimbursements, enter the name of the person to be reimbursed with this payment request.

(2) Vendor Number (if known): Many vendors are in the university’s SAP system. If the vendor is in the system, enter the number here. If you do not know the number, leave it blank. See list of frequently used vendors on the student organization website. The link is provided below.

* (3) Mailing Address: Enter the mailing address of the person or company that you want to pay. This is the address that the check will be mailed to.

* City, State, Zip Code: Include City, State and Zip Code for Mailing Address.

Phone Number: Include a phone number for the vendor so that we can contact them if necessary.

Email Address: Include an email address for the vendor so that we can contact them by email.

(4) Invoice #: If the vendor has provided an invoice for products or services, attach the invoice to this payment voucher, and write in the invoice number here. If you do not know the invoice number, leave it blank.

* Enter Date(s) of purchase or service (mm/dd/yyyy): Enter the date that the purchase was made, or the services were received. Enter two dates if there is a beginning date and an ending date for services. For example, if you are paying someone who has performed choreography services from November 1^st through November 15^th 2009, enter 11/01/2009 – 11/15/2009. If you are paying someone who gave a lecture on October 9^th 2009, enter 10/9/2009.

* (5) TYPE OF PAYMENT (CHECK ONE):

a) Reimbursement – Check here if this payment is for a reimbursement to someone who paid for products or travel expenses. Reimbursement cannot be made for services performed by someone else. Submit a separate payment voucher to directly pay the vendor who performed the services.

b) Products (not for resale) – Check here if this payment is to purchase any type of products, such as party supplies or clothing that will not be resold.

c) Products for Resale – Check here if you are purchasing items that will be resold. The student organization must collect sales tax when selling items and remit the sales tax to the State Comptroller’s office.

d) Cash Award, Scholarship or Gift – Check here if you are paying an individual for an award, gift, or scholarship funds in cash or gift card.

e) Personal or Professional Services – Check here if you are paying an individual or company for performing services. Services include lecturing, performing as a musician or singer, coaching, etc. See list of services for the correct code.

f) Rental – Check here if you are paying a rental fee for the use of a meeting room, vehicles, boats, equipment or land.

* (6) TOTAL AMOUNT REQUESTED: Enter the total dollar amount of the check that you are requesting.

* (7) ACCOUNT ASSIGNMENT: List the items you are purchasing, with the GL Account Number, the Club Account Number, and the Club Name. Additional lines are provided if you are including several items or services in the payment request. The total of all lines must match the total in Item (6).

* $ Amount: Enter the dollar amount for the goods or services.

* GL Account: Enter the General Ledger account number for the goods or services. Refer to list of payment types and General Ledger account numbers provided on the website, “Types of Payments and General Ledger Accounts”.

* Club Account Number: Enter your club account number, which will be provided by the university.

* Club Name: Enter your club’s name.

* (8) Purpose of Payment: Describe who, what, why, where and when. Describe the business purpose of the payment.

(9) Comments – (office use only) Leave this field blank.

* (10) Required Approvals. Must be signed by a Club Advisor and one Club Officer – Include printed names, phone numbers and the email addresses for both the Club Advisor and the Club Officer.