VWS Payment Request Form

Payment Request Form

For all VWS reimbursements and vendor payment requests
Request is for:*

ReimbursementVendor PaymentRefund
If this is the first time VWS has used this vendor, a W-9 must also be submitted.

Include as an attachment to this form.

Blank W-9 Form available at: https://www.irs.gov/pub/irs-pdf/fw9.pdf

Payments will be made by check.
Request Submitted By:*

First NameLast Name
Requester Email Address:*
example@example.com
Expense Description *
Is this a Hub Expense?*

YesNo
Please Select a Hub
Amount Requested:*
Notes
Any other pertinent information about this request
Payment method preference*
If you choose electronic funds transfer, you will receive a code word from vermontws@gmail.com and an email with a link to set up the funds transfer (entering the code word and your bank routing and account numbers) from billpaysupport@billpaysite.com
Payable To:*

First NameLast Name
Payable To Email Address:*
example@example.com
Payee Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Receipts/Invoices/W-9 Here

Cancelof
Should be Empty: