Payment Request Form

For reimbursements, mileage, contract labor, and vendors

For each person or company who is to be paid by direct deposit, we must have a signed Direct Deposit Authorization Form submitted by the Executive Director giving us permission to set up a direct deposit payment. If you do not have one on file for this payee - see the statement in red at the top of the page. The form must be submitted before a direct deposit can be made.

Tell us what expense account(s) to use to record your reimbursement, vendor payment, mileage, or advanced funds. List Accounts Separately: (refer to your AP Chart of Accounts for account numbers) Use the + button to add additional rows IF YOU AREN’T SURE WHICH ACCOUNT TO USE, WRITE A DETAILED DESCRIPTION AND WE WILL CHOSE THE APPROPRIATE ACCOUNT

For Mileage Reimbursement: Please complete the Payee Information and Payment Method sections on page 1. Then use the formula below to find the total amount. The amount will be automatically accounted to your Mileage Account, usually Account # 800

Under special circumstances, we can issue a payment in advance of the expense being incurred. A common example might be group travel expenses, like food or lodging, when large amounts will be spent and you prefer not to pay out-of-pocket and be reimbursed later. Also, occasionally event vendors require payments/deposits before an official invoice is issued.