Direct Payment Request Form

Direct Payment Request

Use this form for direct vendor payment of invoices or purchase orders.
The Board Member or Committee Chair responsible 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
Title*
Email*
example@example.com
Vendor and Purchase Information
Vendor Name*
Payment Type:*
Payment Information (If check request, enter address to mail check; if online payment, enter information to make payment)
Total Invoice/Purchase Amount ($)*
Invoice Number:*
Invoice Date*

MonthDayYear
Date
Due Date*

MonthDayYear
Date
Purpose of Purchase*
Upload PDF of Invoice

Cancelof
Further Explanation (Optional)
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 Ozark Swimming, Inc.
Signature*

Clear
Name of Signer*

First NameLast Name
Should be Empty:

Direct Payment Request