ASI Club Check Request

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

Please contact the ASI Business office at asiaccounting@csus.edu or at (916) 278-2231 for any questions or concerns.
PARTY TO BE PAID:
Vendor Full Name*
Party to pay/reimburse
Total Amount to be Paid*
ex: 19.56
Address*

Street Address

Street Address Line 2 (If Applicable: Enter Apartment or Suite Number)

CityState / Province

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

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

SUPPLIES:
- General Equipment & Supplies
- Gift Cards/Certificates
- Food
- Membership Dues
- Conference/Meeting Registration
- Awards/Scholarships
- Donations
- Any Other Club Expense
TRAVEL:
- Mileage/Gas Expenses
- Car Rental
- Hotel Expenses
- Bus, Train, Airfare 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 amount of attendees for this event/meeting exceed 25?*
Please attach a form of the list of attendees and their business relationship to campus:

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What is the cost of the meal per each attendee?*
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 4 W's ("What", "Why", "Who", and "Where")

Supplies
Categories:
- General Equipment & Supplies
- Gift Cards/Certificates
- Food
- Membership Dues
- Conference/Meeting Registration
- Awards/Scholarships
- Donations
- Any Other Club Expense
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:*
Total Amount of Supplies to pay from Club:*
If using DOC funds, was event open to all Sac State Students? *
If Items were ordered/shipped, were all Items received?
Please provide a description/reason for payment/reimbursement:*
*** PLEASE READ & SUBMIT ALL NECESSARY DOCUMENTS PER CATEGORY, OR YOUR REQUEST CAN & WILL BE DENIED ***
For SUPPLIES/GIFT CARD/FOOD payments & reimbursements:
Please attach required:

1. Invoice/Receipts

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card used, attach an image of that CC showing only the last 4 digits and full name. 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 are shipped, provide proof of delivery or state "all items received" in description. For example: packing slips, pictures of the items, confirmation of delivery page.
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

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

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For CONFERENCE/MEETING Registration payments & reimbursements:
Please attach:

1. Invoice/Receipts

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card used, attach an image of that CC showing only the last 4 digits and full name. 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 Attendance. For example: name badges, conference registration, flyers, pictures at the event, conference schedule given at events, etc.

4. List of Attendees and/or registrants if more than 1.
Please attach necessary documents for CONFERENCE/REGISTRATION payments here:

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For AWARDS/SCHOLARSHIP payments:
Please attach:

1. Application of the winner

2. Meeting Minutes

3. Process of how the winner was chosen

4. Include Student ID #
Please attach necessary documents for AWARDS/SCHOLARSHIPS here:

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For DONATIONS/CONTRIBUTIONS:
Please attach:

1. Signed Memo explaining the donation

2. Information on organization receiving the donation

↳ website print out ok
Please attach necessary documents for DONATIONS/CONTRIBUTIONS here:

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

1. Invoice/Receipts

2. Proof of Payment (ONLY IF BEING REIMBURSED)

↳ If receipts show the last 4 digits of the Credit Card used, attach an image of that CC showing only the last 4 digits and full name. 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
- Bus, Train, Airfare Travel
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:*
Total Amount of Travel to pay from Club:*
Please provide a brief description of the 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. Print-out of Total Route Traveled (i.e., Google Maps)*

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

2. Proof of Event. For example: name badges, conference registration, pictures at the event, flyers, conference schedule given at events, etc.

* Club officers can impose a limit on the amount that can be reimbursed 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 that the "Amount to be Paid" section on the check request form matches the limit.

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

Please note mileage expenses for privately owned automobiles will be reimbursed using the CSUS Business Mileage Rate, currently at $0.67/mile
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For CAR RENTALS payments, reimbursements, or gas receipts:
Please attach:

1. Receipt/Contract of Car Rental/Gas Receipts (if reimbursing for gasoline)

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card used, attach an image of that CC showing only the last 4 digits and full name. 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 CAR RENTALS here:

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For HOTEL EXPENSES payments & reimbursements:
Please attach:

1. Receipt/Invoice

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card used, attach an image of that CC showing only the last 4 digits and full name. 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 Attendance to event
Please attach necessary documents for HOTEL EXPENSES here:

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

1. Invoice/Receipt

2. Proof of Payment

↳ If receipts show the last 4 digits of the Credit Card used, attach an image of that CC showing only the last 4 digits and full name. 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 Conference Attendance. For example: name badges, conference registration, pictures at the event, flyers, conference schedule given at events, etc.

5. Copy of the University Travel Waiver IF paying in advance for 15+ students
Please attach necessary documents for BUS, TRAIN, AIRFARE TRAVEL here:

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Outside Services
Categories:
- Contracted Services
- Honoraria
- Speaker/Performer Fees
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:*
Total Amount of Contracted Services to pay from Club:*
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. MOA for Contracted Services

↳ If paying the vendor in installments during the semester, have the vendor and the club/club officers sign one Memorandum of Agreement (MOA) for the full amount with the breakdown of payment terms in the specified section. Additionally, resubmit the 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).

2. W-9 from entity providing services

↳ If the contractor has been previously paid by ASI, 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 W9.

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*
example@example.com
Signature #2

Clear
Name of Authorized Signer #2*

First NameLast Name
Phone Number*
(123) 456-7890
E-mail*
This is the email where your form will be sent for second signing.

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 request will be denied and will need to be resubmitted with necessary documentation.

3. Signature(s) (from most current CAF on File) has been provided for approval. *NOTE vendor/payee cannot authorize their own request, i.e., Treasurer can not authorize their own reimbursement, only 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!