FSC Payment Authorization Request FormThis 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 CobbJenn DeLa'OJon StudtmannLeisa HesebeckLisa LivdahlRobin BowersockSonya TodacheeneStacy CantrellTheresa CominskyTracey SewardSP-AAH Staff OnlyChoose 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 - 10232Dept. 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 - 10214Dept. Abbreviation/Org. # (M-Z)- None -MASP - 10198MATH - 10176MENV - 11119 / ORE - 11297PAC RAP - 10223PACS - 10226PHIL - 10239PSCI - 10184PSYC - 10190PWR - 10723RAPG - 10889RAPHP - 10992RAPL - 10839RAPS - 10224RLST - 10241SBO - 10199SLHS - 10216SOCY - 10219SPAN - 10242THDN - 10243WGST - 10220Please just choose one department from the lists.Form completed byIRS W-9 FormPlease 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 UploadOne 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 FieldsFirst additional fileOne 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 fileOne 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 fileOne 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 fileOne 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 fileOne 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 fileOne file only.20 MB limit.Allowed types: bmp, eps, tif, pict, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml. SpeedtypeTotal Amount$ÌýNeed more speedtype/amount fields?ÌýYesÌýNoAdditional SpeedtypeAdditional total amount$ÌýNeed more speedtype/amount fields?ÌýYesÌýNoAdditional SpeedtypeAdditional total amount$ÌýPayee nameStreet AddressCity, State, Zip-codePayee typeÌýNon-employeeindividual or entityÌýNon-employeestudentÌýForeign nationalIndividual or entityÌýEmployeeIf petty cash custodian paymentÃÛÌÇÖ±²¥ Employee? (Petty cash only)ÌýYesÌýNoIf yes, employee ID?ÃÛÌÇÖ±²¥ Student?ÌýYesÌýNoIf yes, student ID?Warrant deliveryWarrant deliveryÌýRegular mailÌýCampus mailÌýForeign mailÌýWire transferSelect one: If selecting wire transfer; Please include a completed Wire Payment Request form, see the button at the top of this form.Payment PurposeWhat is the payment for?Campus mailbox #Business PurposeAdditional CommentsWould you like an emailed copy of this form sent to you?ÌýYesÌýNoEnter 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.
