PAYMENT/REIMBURSEMENT AUTHORIZATION FORM
STUDENT ORGANIZATIONS - HOUSES - ENTRIES
Vendor Legal Name:

Social Security Number or Tax ID Number:

Address:

Vendor Classification: Wms Employee
Wms Student
Other

Payment Method: Check
Direct Deposit

Special Handling: Enclosure
Pickup (Emergencies Only)

Account (6) Fund (3)

Dept ID (7)

Today's Date Amount-insert decimal
Event Name: Event Date:
Item Description:
Account (6) Fund (3) Dept ID (7) Today's Date Amount-insert decimal
Event Name: Event Date:
Item Description:
Account (6) Fund (3) Dept ID (7) Today's Date Amount-insert decimal
Event Name: Event Date:
Item Description:
Student Organization/House/Entry: (requesting funds)
Finance Officer's Name
E-mail address:
***Office Use Only***

College Council - Authorization:________________________________________ Date:____________
Campus Life Office, Multicultural Center - Authorization:________________________ Date:_____________