Payment Request Form

The Payment Request Form may be used for those types of activities for which little or no value can be added by processing the transaction through standard procurement procedures. Examples of when the Payment Request Form may be used include reimbursements, hospitality expenses, and low dollar purchases not made using a ProCard.

Campus departmental personnel shall utilize the Payment Request Form for a direct pay. Included must be name, campus address, campus identification number clearly stated, a description of payment, and receipts of the procurement or invoice. The receipt must be itemized and specific. A claim for “miscellaneous merchandise” will not be reimbursed. Receipts should indicate payment, shipping/delivery and dates of completion. If an itemized receipt is not available, a “lost receipt memo” will need to be attached with the proper authorizing signatures.

Once complete, the signed form and receipts/invoice should be emailed to: