Direct Payment Request

Direct Payment Request

Use this form for direct vendor payment of invoices or purchase orders.
The Executive Committee member responible for the budget line payment will be processed from should fill out the form.
Contact Information

Please provide contact information for the person making the request.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Vendor and Purchase Information
Vendor Name*
Payment Type*

One Time Purchase/PaymentRecurring Purchase/Payment
Single Purchase Information
Total Invoice/Purchase Amount*
Invoice Date*

MonthDayYear
Date
Due Date*

MonthDayYear
Date
Recurring Purchase Information
You may approve recurring payments using this form. The Treasurer must receive a copy of the invoice if it is to be p by check each billing period. The Treasurer must receive a copy of the invoice and/or receipt for any payments automatically paid by LSC debit card or checking account. Recurring invoices may be emailed directly to the Treasurer.
Billing Frequency*
Describe how often and at what point during the period payment should be expected (monthly, every 6 months, yearly, etc.)
Maximum Approval Amount for Each Payment Period*
If the billing amount is the same each month, enter this amount. If it may change, enter the maximum amount being approved without further approval.
Approval Expiration

MonthDayYear
Approval for recurring payments will expire on August 31 of the current fiscal year. If the approval should end prior to August 31, indicate so here.
Upload PDF of Invoice

Cancelof
Niagara LSC Information
If invoice total exceeded $250, were multiple bids secured?

Yes, provide alternate vendors contacted in next question.No, provide explanation of no alternative bids.
Please provide details to previous question.
Budget Line*
Further Explanation
Please provide any other details that may be helpful in processing your request. Include meeting minute references if this is non-routine or off budget-line request.
By signing below, you attest that all information provided in your reqeust is true and accurate. In addition, your request is in accordance with the Bylaws and Policies and Procedures of Niagara Swimming, Inc.
Signature*

Clear
Name of Signer*

First NameLast Name
Title*
Should be Empty:

Direct Payment Request

Contact Information

Vendor and Purchase Information

Single Purchase Information

Recurring Purchase Information

Niagara LSC Information