ASI Club Check Request

Club Check/Transfer Request
** It is the club/organization's responsibility to read the instructions and ensure that all submitted requests are complete. Incomplete check requests will not be accepted. **

Additional resources can be found on our website, including videos! Please contact ASI Accounting Services at asiaccounting@csus.edu or (916) 278-2231 with any questions or concerns.
PARTY TO BE PAID:
Vendor Name*
Party to pay/reimburse
Total Amount to be Paid*
Address*

Street Address

Street Address Line 2 (if applicable, include Apartment or Suite Number)

CityState / Province

Postal / Zip Code
Phone Number*
(123) 456-7890
Email*
example@csus.edu

Club Information
Club Name*
Club Account # *
Account example: 03XXX
CATEGORIES UNDER EACH ACCOUNT:

SUPPLIES:
- General Equipment & Supplies
- Gift Cards/Certificates
- Food and/or Beverages
- Membership Dues
- Conference/Convention/Meeting Registration
- Awards or Scholarships
- Donations
- Any Other Club Expense
TRAVEL:
- Mileage/Gas Expenses
- Car Rental
- Hotel Expenses
- Rideshare (Lyft, Uber, taxi)
- Bus, Train, Air Travel
OUTSIDE SERVICES:
- Contracted Services
- Honoraria
- Speaker/Performer Fees
What Account(s) will be used?*

SuppliesTravelOutside Services

Event/Meeting Hospitality
What type of hospitality is this? *
What type of event/meeting is this?*
Is the event/meeting reoccurring? *
*If it is reoccurring, you must submit a separate check request for each event/meeting being held*
State the Date of the event/meeting*
Name the location of the event/meeting*
Did the number of attendees for this event/meeting exceed 25?*
Please attach a list of attendees (first and last names) and their business relationship to campus (e.g. student, faculty, staff, etc.):

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What is the cost of the meal per each attendee?*
If food or refreshments were not served, enter $0.
Please provide a description of the group of people that attended: *
What is the approximate cost of the meal per each attendee? *
Please provide a description/reason for the purpose of this event/meeting:*
Please include the four Ws ("What," "Why," "Who," and "Where")

Supplies
Categories:
- General Equipment & Supplies
- Gift Cards/Certificates
- Food and/or Beverages
- Membership Dues
- Conference/Convention/Meeting Registration
- Awards or Scholarships
- Donations
- Any Other Club Expense (e.g. Union WELL room rental and fees, etc.)
Club & DOC Funds

We highly encourage you to use your DOC funds (when eligible) before using your club funds! If there are insufficient DOC funds available, then club funds can be used to cover the remaining amount.

Please have an authorized signer contact us asiaccounting@csus.edu or visit us in-person with a photo I.D. for a report of your club and DOC balances to help your club make the most of your funds!
Are you using DOC Funds? Club Funds? Combination of Both?*

DOC Funds (cannot exceed clubs' total awarded DOC)Club FundsSplit between DOC Funds and Club Funds
Total amount of Supplies to pay from DOC funds:*
Total amount of Supplies to pay from Club funds:*
If using DOC funds, was the event open to all Sac State Students? *
Please provide a description/reason for payment/reimbursement and confirm if any items ordered online were received:*
*** PLEASE READ & SUBMIT ALL NECESSARY DOCUMENTS PER CATEGORY, OR YOUR REQUEST CAN & WILL BE DENIED ***
For SUPPLIES/GIFT CARD/FOOD payments & reimbursements:
Please attach:

1. Itemized Invoice/Receipt

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card (CC) used, attach an image of that CC showing only the last 4 digits and cardholder's full name. The last four digits on the card should match the number on the receipt.

For example:

↳ If receipts do not show last 4 digits of the Credit Card used, attach a bank/credit statement or transaction history showing the transaction charge and full name of vendor/payee.

3. If items were ordered online and shipped, provide proof of delivery or state "all items were received" in the description above. Proof of delivery examples: packing slip, delivery confirmation, picture of the item received

Note: Voluntary tip/gratuity is reimbursed up to a maximum of 15% of the bill's subtotal (not including taxes) AND must be paid with a debit/credit card. Cash tips are NOT reimbursable. Attach the itemized receipt and the debit/credit card statement to show the total amount paid (including tip).

If alcohol is listed within the itemized receipt, we will deduct the alcohol and associated sales/use tax from the reimbursement amount as alcohol is an unallowable expense.
Please attach necessary documents for SUPPLY/GIFT CARD/FOOD here:

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For MEMBERSHIP DUES payments & reimbursements:
Please attach:

1. Invoice to pay or receipt

2. List of Paying Members' Names
Please attach necessary documents for MEMBERSHIP DUES here:

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For CONFERENCE/CONVENTION/MEETING REGISTRATION payments & reimbursements:
Please attach:

1. Itemized Invoice/Receipt

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card (CC) used, attach an image of that CC showing only the last 4 digits and cardholder's full name. The last four digits on the card should match the number on the receipt.

For example:

↳ If receipts do not show last 4 digits of the Credit Card used, attach a bank/credit statement or transaction history showing the transaction charge and full name of payee.

3. List of attendees and/or registrants, if more than one person.
Please attach necessary documents for CONFERENCE/CONVENTION/MEETING REGISTRATION payments here:

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For AWARD/SCHOLARSHIP payments:
Please attach:

1. Application of the winner

2. Meeting minutes, email, or social media announcement that your club/organization is offering a(n) scholarship/award

3. Process of how the winner was chosen

4. For scholarships, include winner's Sac State Student ID #

5. For awards, include the winner's completed and signed W-9
Please attach necessary documents for AWARDS/SCHOLARSHIPS here:

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For DONATIONS/CONTRIBUTIONS:
Please attach:

1. Signed Memo explaining the donation (include date, organization name, address of organization, amount of donation, signature of an authorized signer)

2. Information on organization receiving the donation

↳ screenshot of the website is acceptable
Please attach necessary documents for DONATIONS/CONTRIBUTIONS here:

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For ANY OTHER CLUB EXPENSE not mentioned above:
Please attach:

1. Itemized Invoice/Receipt or Invoice to Pay (e.g. Union Well room rental and fees)

2. Proof of Payment (ONLY IF BEING REIMBURSED)

↳ If receipts show the last 4 digits of the Credit Card (CC) used, attach an image of that CC showing only the last 4 digits and cardholder's full name. The last four digits on the card should match the number on the receipt.

For example:

↳ If receipts do not show last 4 digits of the Credit Card used, attach a bank/credit statement or transaction history showing the transaction charge and full name of vendor/payee.
Please attach necessary documents for ANY OTHER CLUB EXPENSE here:

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Travel
Categories:
- Mileage/Gas Expenses
- Car Rental
- Hotel Expenses
- Rideshare (Lyft, Uber, taxi)
- Bus, Train, Air Travel
Club & DOC Funds

We highly encourage you to use your DOC funds (when eligible) before using your club funds! If there are insufficient DOC funds available, then club funds can be used to cover the remaining amount.

Please have an authorized signer contact us asiaccounting@csus.edu or visit us in-person with a photo I.D. for a report of your club and DOC balances to help your club make the most of your funds!
Are you using DOC Funds? Club Funds? Combination of Both?*

DOC Funds (cannot exceed clubs' total awarded DOC)Club FundsSplit between DOC Funds and Club Funds
Total amount of Travel to pay from DOC funds:*
Total amount of Travel to pay from Club funds:*
Please provide a brief description of the travel purchases:*
*** PLEASE READ & SUBMIT ALL NECESSARY DOCUMENTS PER CATEGORY, OR YOUR REQUEST CAN & WILL BE DENIED ***
For MILEAGE/GAS EXPENSES when traveling via a PERSONAL VEHICLE payments & reimbursements:
Please attach:

1. Printout of the Total Route Traveled (e.g. Google Maps)*

↳ Must use CSUS as the starting location

California State University, Sacramento (6000 J Street, Sacramento, CA 95819)

2. Proof of Event Attendance. For example: name badge, pictures at the event, flyers or program schedule given at event, etc.

* Note: Club officers can impose a limit on the reimbursement amount to the vendor by specifying the limit in the description. Additionally, if the amount that could be reimbursed exceeds the limit imposed by the club, ensure the "Amount to be Paid" section on the check request form matches the limit.

If the vendor is using a rental vehicle, please proceed to the car rental section.
Please attach necessary documents for MILEAGE/GAS EXPENSES here:

Note: mileage expenses for privately owned automobiles will be reimbursed using the CSUS Business Mileage Rate, currently at $0.70/mile
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For CAR RENTAL payments, reimbursements, or gas receipts:
Please attach:

1. Car Rental Agreement/Receipt

2. Gas Receipts (if reimbursing for gasoline)

3. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card (CC) used, attach an image of that CC showing only the last 4 digits and cardholder's full name. The last four digits on the card should match the number on the receipt.

For example:

↳ If receipts do not show last 4 digits of the Credit Card used, attach a bank/credit statement or transaction history showing the transaction charge and full name of vendor/payee.

4. Proof of Event Attendance. For example: name badge, pictures at the event, flyers or program schedule given at event, etc.
Please attach necessary documents for CAR RENTALS here:

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For HOTEL EXPENSES payments & reimbursements:
Please attach:

1. Itemized Invoice/Receipt

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card (CC) used, attach an image of that CC showing only the last 4 digits and cardholder's full name. The last four digits on the card should match the number on the receipt.

For example:

↳ If receipts do not show last 4 digits of the Credit Card used, attach a bank/credit statement or transaction history showing the transaction charge and full name of vendor/payee.

3. Proof of Event Attendance. For example: name badge, pictures at the event, flyers or program schedule given at event, etc.
Please attach necessary documents for HOTEL EXPENSES here:

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For RIDESHARE reimbursements:
Please attach:

1. Itemized Invoice/Receipt

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card (CC) used, attach an image of that CC showing only the last 4 digits and cardholder's full name. The last four digits on the card should match the number on the receipt.

For example:

↳ If receipts do not show last 4 digits of the Credit Card used, attach a bank/credit statement showing the transaction charge and full name of vendor/payee.

3. Proof of Event Attendance. For example: name badge, pictures at the event, flyers or program schedule given at event, etc.
Please attach necessary documents for RIDESHARE expenses here:

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For BUS, TRAIN, AIR TRAVEL payments & reimbursements:
Please attach:

1. Itemized Invoice/Receipt

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card (CC) used, attach an image of that CC showing only the last 4 digits and cardholder's full name. The last four digits on the card should match the number on the receipt.

For example:

↳ If receipts do not show last 4 digits of the Credit Card used, attach a bank/credit statement or transaction history showing the transaction charge and full name of vendor/payee.

3. Proof of Travel

↳ boarding passes, itineraries, airline tickets, etc.

4. Proof of Event Attendance. For example: name badge, pictures at the event, flyers or program schedule given at event, etc.

5. Copy of the University Travel Waiver if paying in advance for 15+ students

↳ https://www.csus.edu/academic-affairs/internal/_internal/_documents/field-trip-student-waiver-form.pdf
Please attach necessary documents for BUS, TRAIN, AIR TRAVEL here:

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Outside Services
Categories:
- Contracted Services
- Honoraria
- Speaker/Performer Fees
Club & DOC Funds

We highly encourage you to use your DOC funds (when eligible) before using your club funds! If there are insufficient DOC funds available, then club funds can be used to cover the remaining amount.

Please have an authorized signer contact us asiaccounting@csus.edu or visit us in-person with a photo I.D. for a report of your club and DOC balances to help your club make the most of your funds!
Are you using DOC Funds? Club Funds? Combination of Both?*

DOC Funds (cannot exceed clubs' total awarded DOC)Club FundsSplit between DOC Funds and Club Funds
Total amount of Contracted Services to pay from DOC funds:*
Total amount of Contracted Services to pay from Club funds:*
Please provide a brief descriptions of the contracted services:*
*** PLEASE READ & SUBMIT ALL NECESSARY DOCUMENTS PER CATEGORY, OR YOUR REQUEST CAN & WILL BE DENIED ***
For CONTRACTED SERVICES/HONORARIA/SPEAKER FEES payments:
Please attach:

1. Memorandum of Agreement (MOA) for Contracted Services

↳ MOA found here: https://asi.csus.edu/sites/main/files/file-attachments/memorandum_of_agreement_2.pdf?1725043589

↳ If paying the vendor in installments during the semester, have the vendor and the club officer(s) sign one MOA for the full amount with the breakdown of payment terms in the specified section. Additionally, submit a new check request with the signed MOA each time a payment needs to be made to the vendor. A new MOA does not need to be filled out.

Note:

If the vendor is a student, include their Student ID number.

If the vendor is employed by CSUS, the vendor's supervisor must sign and date the second page.

2. Completed W-9 from entity providing services (with signature and date)

↳ W-9 found here: https://www.irs.gov/pub/irs-pdf/fw9.pdf

↳ If the contractor has been previously paid by ASI and does not require another W-9 submission, please select "Yes" to the succeeding question.
Please attach necessary documents for CONTRACTED SERVICES/HONORARIA/SPEAKER FEES here:*

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Has The Vendor Been Previously Paid by ASI?
Please ensure you have uploaded the vendor's signed and dated W-9.

Club Authorization
Does your club require 2 signatures (as stated on your Club Accounting Form)?*

YesNo
Signature #1*

Clear
Name of Authorized Signer #1*

First NameLast Name
Phone Number*
(123) 456-7890
E-mail Address*
example@csus.edu
Signature #2

Clear
Name of Authorized Signer #2*

First NameLast Name
Phone Number*
(123) 456-7890
E-mail Address*
This is the email address where your form will be emailed to for the second signature authorization

Almost done!
Please make sure...

1. The vendor/party information is accurate and amount to be paid is correct.

2. All the required documentation has been uploaded/attached, based on instructions, otherwise, the request will be denied and will need to be resubmitted with necessary documentation.

3. Signature(s) from most current Club Accounting Form on file has been provided for approval.

Note: vendor/payee cannot authorize their own request. E.g. Treasurer cannot authorize their own reimbursement. Only the President or other authorized signer can sign/submit the Treasurer's reimbursement, etc.

To complete your check request, click the 'submit' button below.
Should be Empty:

Club Check/Transfer Request

PARTY TO BE PAID:

Club Information

Event/Meeting Hospitality

Supplies

Travel

Outside Services

Club Authorization

Almost done!