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Summary: Accounts Payable
Honoraria and Fees Information Sheet
(1) University Purchase and Check Request Number
(2) PAYEE:
ADDRESS:
(3a) INDIVIDUAL - SSN
(3b) Check One: US Citizen Permanent Resident Alien
(4) COMPANY - Federal Employer Identification Number
(5) Fee For Services Rendered $
Reimbursable Expenses (Where Separately Stated) $
Total Amount To Be Paid $
(6) TYPE OF SERVICE:
Architect Engineer
Attorney Visiting Lecturer
Physician Prospective Employee Travel
Veterinarian Other
(7) Date(s) of Service(s) Performed
(8) Description of Service(s) Performed:
(9) Signature Date
The above services were purchased in accordance with provisions of the University's Administrative Policies and Proce-
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