CHECK REQUEST (NON-INVOICE PAYMENT)

UNIVERSITY OF TULSA

DATE

TU-411-G.CA

INSTRUCTIONS:  IF PAYMENT IS FOR HONORARIUM, LECTURE FEE, CONSULTING FEE OR OTHER TAX REPORTABLE PAYMENT TO A NON-EMPLOYEE, ENTER SOCIAL SECURITY NUMBER AND SHOW HOME ADDRESS.  INVOICES FOR MATERIAL/EQUIPMENT MUST BE PROCESSED THROUGH PURCHASING WITH AN A

TO:             ACCOUNTS PAYABLE

FROM:

PLEASE ISSUE CHECK PAYABLE TO:

PAYEE SOCIAL SECURITY NUMBER OR DATATEL ID #:

NAME:

ADDRESS:

CHECK AMOUNT:

If traveling, please give travel dates & date check needed:

Indicate to Mail Check, Campus Mail, or Pick-up at Business Office:

APPROVALS

EMPLOYEE SIGNATURE

APPROVAL

PRINT NAME

PRINT NAME

APPROVED SIGNATURE

APPROVAL

PRINT NAME

PRINT NAME

ACCOUNT NUMBER(S)

AMOUNT(S)