Policy Manual

Foundation Payment Request Form

Georgia College & State University Foundation, Inc.

Request for Payment from Foundation Contributed Funds

ACCOUNT NAME & NUMBER:

INVOICE NUMBER:

INVOICE DATE:

INVOICE DUE DATE:

FOR: (Attach receipts for reimbursements of items purchased, or explanation when services are rendered.)

AMOUNT OF THIS PAYMENT:

$

CHECK PAYABLE TO:

ADDRESS:

SOCIAL SECURITY/TAX ID NUMBER:
(if applicable)

IF CHECK IS TO BE SENT TO PERSON OTHER THAN PAYEE, GIVE NAME AND ADDRESS:

PERSON REQUESTING PAYMENT: (Signature and Date)

APPROVALS:

Signature

Date

DIVISION/DEPARTMENT HEAD

FOUNDATION:

Signature

Date

TREASURER:

Signature

Date

Signature

Date

* DELIVER FORM TO: GCSU FOUNDATION, CAMPUS BOX 113, 208 Parks Hall