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Vendor Payment Request
For Internal Use Only (Please do not share with vendors)
Date Submitted
-
Month
-
Day
Year
Date
Event Name
*
Should match corresponding Event Proposal (EP)
EP# (or Contract#)
The EP# can be found on Monday.com Event Proposal Board; Contract#s are provided once finalized
Chapter Requestor Name
Chapter Requestor Email
example@example.com
Chapter
*
Please Select
Bay Area
Buenos Aires
Central Florida
Chicago
Cuidad Mexico
Dallas
Houston
Iquitos
Lima
Los Angeles
New York
Puerto Rico
Puira
San Diego
South Florida
Tijuana
United Board
Veracruz
New
Type of Request
*
Vendor Registration + Invoice Payment (New Vendor)
Vendor Registration Only (New Vendor)
Invoice Payment Only (Existing Vendor)
Vendor Information
Existing or New Vendor
Existing Vendor
New Vendor
Unsure - maybe already registered
Vendor's Legal Name
*
Should match W9 exactly
Vendor ID
If unknown, leave blank
Vendor Primary Contact
*
First Name
Last Name
Vendor Phone Number
-
Country Code
-
Area Code
Phone Number
Vendor Email (Finance)
*
example@example.com
Vendor Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Accounting Information
Company Code
1001 - AIDS Healthcare Foundation (AHF)
1002 - Pharmacy for Humanity (P4H)
Company Code (Number Only)
AHF WBS
*
Please Select
7010000001 - LOUD - CENTRAL FLORIDA
7010000002 - LOUD - CHICAGO
7010000003 - LOUD - DALLAS
7010000004 - LOUD - HOUSTON
7010000005 - LOUD - LOS ANGELES
7010000006 - LOUD - NEW YORK
7010000007 - LOUD - OAKLAND
7010000008 - LOUD - PUERTO RICO
7010000009 - LOUD - SAN DIEGO
7010000010 - LOUD - SOUTH FLORIDA
7010000011 - LOUD - UNITED BOARD
7019000001 - LOUD - LIMA
7019000002 - LOUD - TIJUANA
7019000005 - LOUD - BUENOS AIRES
7019000006 - LOUD - CUIDAD MEXICO
7019000007 - LOUD - PIURA
7019000008 - LOUD - VERACRUZ
N/A - Non-WBS Budget
P4H WBS
Please Select
7010000012 - LOUD - CENTRAL FLORIDA
7010000013 - LOUD - CHICAGO
7010000014 - LOUD - DALLAS
7010000015 - LOUD - HOUSTON
7010000016 - LOUD - LOS ANGELES
7010000017 - LOUD - NEW YORK
7010000018 - LOUD - OAKLAND
7010000019 - LOUD - PUERTO RICO
7010000020 - LOUD - SAN DIEGO
7010000021 - LOUD - SOUTH FLORIDA
7010000022 - LOUD - UNITED BOARD
7019000003 - LOUD - LIMA
7019000004 - LOUD - TIJUANA
7019000005 - LOUD - Buenos Aires
7019000006 - LOUD - Cuidad Mexico
7019000007 - LOUD - Piura
7019000008 - LOUD - Veracruz
N/A - Non-WBS Budget
AHF GL
*
Please Select
66400001 - Organizational Event
66120001 - Advertising - Premiums & Swag
66130001 - Advertising - Collateral
67300001 - Education/training
67200001 - Conferences/meetings
67400001 - Dues/subscriptions
68100003 - Auto - Mileage
67180001 - Employee Entertainment/Meals
67110001 - Travel - Airfare
67140002 - Travel - Meal Per Diem
67120001 - Travel - Lodging
67130001 - Travel – Car/Transportation
68300001 - Office Supplies
68400001 - Printing
68200001 - Postage/messenger
62200003 - Security Expense
68500000 - Storage Expense
63800000 - Software as a Subscription
65100000 - Consultants/Contractors (Non-Facility)
63000000 - Rent Expense
P4H GL
*
Please Select
66330001 - Contributions - Corporate Sponsorships
Invoice Information
Invoice Date
*
-
Month
-
Day
Year
Invoices are paid net 30; please backdate at least two weeks to expedite if vendor cannot wait the whole 30 days
Invoice No.
*
Invoice Amount
*
Enter only numbers
Description of Services/Goods
*
Notes/Comments
Invoice
*
Browse Files
Drag and drop files here
Choose a file
Needs to have a unique invoice# and match W9 vendor info
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of
W9/ Vendor Packet
Browse Files
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Choose a file
Cancel
of
Contract
Browse Files
Drag and drop files here
Choose a file
Required for a) one-time payments over $5k or b) repeat payments over $600/year
Cancel
of
P4H Cover Page for Sponsorships
*
Browse Files
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Should be filled out by Chapter member NOT the vendor
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of
Additional Documents
Browse Files
Drag and drop files here
Choose a file
i.e. Sponsorship Letter/deck (required for all sponsorships), Supporting Documentation
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of
Save
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