Fillable Non-Employee Compensation Check Request Form printable pdf download

Non-Employee Compensation Check Request Form

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NON-EMPLOYEE COMPENSATION

CHECK REQUEST

Payment to a person or non-incorporated business for a service-

performer, lecturer, speaker, presenter, wait staff, honorarium,

stipend, grant

FORM 1

SUPPORTING DOCUMENTATION MUST BE ATTACHED

Complete entire form

ADDITIONAL INSTRUCTIONS ON REVERSE SIDE

PLEASE DIRECT ALL QUESTIONS CONCERNING THIS FORM TO 588-6413

ISSUE CHECK TO:

DISPOSITION INSTRUCTIONS: (Check One)

NAME:

E-CHECK

__________(mandatory for employees and students.)

SOC. SEC. NO.:

MAIL CHECK _________

W-9 COMPLETED/ON FILE ______________________

PICKUP at Student Account’s ______

ADDRESS:

REQUIRED FOR PAYMENT

DEPT. NAME:

SERVICE PERFORMED:

REQUESTOR:

SIGNATURE:

DATE(S) OF SERVICE:

PRINT NAME: __________________

FEE FOR SERVICE:

PHONE EXT:

REIMBURSABLE EXPENSES:

DATE: ________________________

TOTAL CHECK AMOUNT:

APPROVED BY:

SIGNATURE:

AMOUNT

ACCOUNT NUMBER

PRINT NAME:

DATE:

____--____________--________

0 0

TOTAL CHECK AMOUNT

SIGNATURE:____________________________________________________

Last updated 2/7/17

Non-Employee Compensation Check Request Form

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