FSC Payment Authorization Request Form This form must be completed in one sitting and cannot be saved to complete later. You must have JavaScript enabled to use this form. Indicates required field Who is your FSC tech? - Select -Amanda LaceyHannah SilverHeather Aguilar ChanchanJames CobbJon StudtmannKelly EadsKylie CookLeisa HesebeckLisa LivdahlNina CraciunRobin BowersockTheresa CominskyTracey SewardSP-AAH Staff Only Choose your Department/Org # (in 1 of the 3 drop downs) Dept. Abbreviation/Org. # (A-D) - None -A&S AAC - 10254A&S Communications - 11306A&S Deans Office - 10153A&S DEI - 11307A&S HR - 11305A&S Student Success - 11318ALC - 10230ALTEC - 10244ANTH - 10206APS - 10158BKHC - 10965CARTSS - 10742CBIS - 10247CHEM - 10167CHEMBIO - 10592CINE - 10233CLAS - 10228CMEMS - 10251COAW - 10248CSF - 10711ÃÛÌÇÖ±²¥AM - 10621CWCV - 10596CWRT - 10232 Dept. Abbreviation/Org. # (E-L) - None -EBIO - 10160ECON - 10208E&ER - 10742ENGL - 10231ENSRAP - 10202ENVS - 10169ETHN - 10212FISKE - 10203FRIT - 10236GEOG - 10170GLBT - 10252GSLL - 10237HIST - 10238HNRS - 10197HRAP - 10201HUMN - 10229IAFS - 10221IPHY - 10175JWST - 10894LALSC - 10961LING - 10214 Dept. Abbreviation/Org. # (M-Z) - None -MASP - 10198MATH - 10176PAC RAP - 10223PACS - 10226PHIL - 10239PSCI - 10184PSYC - 10190PWR - 10723RAPG - 10889RAPHP - 10992RAPL - 10839RAPS - 10224RLST - 10241SBO - 10199SLHS - 10216SOCY - 10219SPAN - 10242THDN - 10243WGST - 10220 Please just choose one department from the lists. Form completed by IRS W-9 Form Please attach a copy of a completed IRS W-9 Form. See the IRS W-9 Form button at the top of this form.One file only.32 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. File Upload One file only.32 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. Open for Additional File Upload Fields First additional file One file only.20 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. Second additional file One file only.20 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. Third additional file One file only.20 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. Fourth additional file One file only.20 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. Fifth additional file One file only.20 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. Sixth additional file One file only.20 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. Speedtype Total Amount $ Need more speedtype/amount fields? Yes No Additional Speedtype Additional total amount $ Need more speedtype/amount fields? Yes No Additional Speedtype Additional total amount $ Payee name Street Address City, State, Zip-code Is Payee a US citizen? Yes No If no, please see the International AP Payment Matrix button above for additional documents required. ÃÛÌÇÖ±²¥ Employee? (Petty cash only) Yes No If yes, employee ID? ÃÛÌÇÖ±²¥ Student? Yes No If yes, student ID? Warrant delivery Warrant delivery Regular mail Campus mail Foreign mail Wire transfer Select one: If selecting wire transfer; Please include a completed Wire Payment Request form, see the button at the top of this form. Payment Purpose What is the payment for? Campus mailbox # Business Purpose Additional Comments Would you like an emailed copy of this form sent to you? Yes No Enter your email address (if multiple, use comma to separate) Multiple email addresses may be separated by commas. Emails are only sent to cc and bcc addresses if a To email address is provided.
