SEAONC Payment Request

SEAONC Payment Request

Requestor (email address)*

Select

Requestor Name (First & Last)*

Total Charge*

Payment Type (How the reimbursement will be made)*

Please select how the payment will be issued to you, or the vendor. SEAONC will typically issue payments via Check or ACH.

This is NOT how you paid the bill you are seeking reimbursement for.

Select or enter value

Check Payable To:*

Payee Email Address*

Email address of the check recipient

Payee Phone Number*

Phone number of the check recipient

Address*

City*

State*

Zip Code*

Reason for Expenditure*

(i.e. YMF August Meeting, Board Meeting Lunch, etc.)

Budgeted Expense?*

Select or enter value

If not budgeted, please explain reason for expense

Class*

Reference current financials or budget

Select

Expense/Budget Code*

Select

Due Date/Paid on Date*

Note: Due date is the last the day the bill should be paid by OR if already paid the date payment was issued.

File Attachments (copy of invoice, W9, receipt, etc.)*

A W9 is required for new vendor payees. If you are submitting for reimbursement, a receipt of your purchase is required. Reimbursements will not be made without a receipt of purchase.

Drag and drop files here or

Comments/Special Instructions (process in different currency, etc.)

Send me a copy of my responses

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