Invoice Voucher/ Receiving Report - University Of Washington
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1UNIVERSITY OF WASHINGTON
INVOICE VOUCHER/
RECEIVING REPORT
Requisition Number
Instructions: Please type. Submit this f o rm to claim payment f o r materials or services.
Department Name/ Phone Number
Box Number
Invoice Date
Invoice Number
STATUS (required)
U. S . Citiz e n
Non-res. Alien
1 0 9 9 Type
U. S . Taxpayer ID Number
Res. Alien
Vendor Control
Use Only
Privacy Act Notice IRC Section 6 1 0 9 requires most recipients o f payments f o r services per f o rmed
to give taxpayer identif i cation numbers to payers w h o must report the payments to IRS. IRS uses
the numbers f o r identif i cation purposes. Payers must be given the numbers w h ether or not recipients
1 . Vendor/Claimant-Name
are required to f i le tax returns . Payers must generally w i thhold taxes f r om taxable payments to a
payee w h o does not f u rnish a taxpayer identi f i cation to a payer . Certain penalties also apply .
2 . Mailing Address
2 . Permanent Address
3 .
3 .
4 .
4 .
5. City (USA)
State
Z I P
5. City (USA)
State
Z I P
5. Country (Foreign)
5. Country (Foreign)
VENDOR'S CERTIFICATE: I hereby certif y that the items and totals listed herein are proper charges
Special Instructions For Handling Checks:
f o r materials , merchandise or services f u rnished to the U
niversity of W ashington .
Signature
Date
Detail Description
Q u an.
Unit
Unit Price
Extended Amount
Item
TOTAL
LESS W/H
CHECK AMT
ACCOUNTING DETAIL
Invoice/Credit Memo No.
OBJ
SUB
SSUB
Budget
Requisition
Invoice
Item
S/L
Use Tax
Liq.
Discount
Number
Number
Amount
Invoice/Credit Memo Date
TASK OPTN
PROJ E CT
TRANSACTION CODE
TERMS:
Net
1 % - 1 0
1 % - 2 0
2 % - 1 0
2 % - 2 0
50
TOTAL
Other:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
$ Amount:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ B y:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Departmental Approval
Material Received By
Date Material Received
Form Reset
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Parent category: Business