subject_line
REQUEST FOR PAYMENT
Enter
your
NDCL email address:
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🛈
First Name
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Last Name
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Choose your type of request
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Employee Expense Reimbursement Request
Employee Mileage Reimbursement Request
Vendor Payment Request
Mailing Choice
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Reimburse via Payroll (for ALL employee requests)
Send Payment to Vendor
Return check to me for mailing
Today's
date:
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+
Payable name:
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Amount of Reimbursement or Vendor Payment
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Amount of Mileage Reimbursement ( calculate: #miles driven * 0.67 rate for 2024)
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If a VENDOR PAYMENT amount is greater than $500, enter your Request for Authorization to Purchase approval number.
You should have received this number in an email from the administrator who approved the purchase.
To which Department will this expense be allocated?
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Instructional (Faculty & Classroom)
Non-Instructional / Administration
Clubs
Athletics
Admissions
Maintenance
Advancement
General Ledger Account Number (if known). Otherwise, leave blank.
Please describe the purchase, including such information as item name, purpose (department or project), and quantity.
For mileage, indicate DATE, DESTINATION, PURPOSE, TOTAL MILES DRIVEN.
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Upload a copy of your receipt or invoice (REQUIRED FOR ALL INVOICE PAYMENTS AND PURCHASE REIMBURSEMENTS):
Please select the appropriate administrator to whom this form should be submitted:
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Dr. Jacqueline Hoynes (FOR ALL REQUESTS MORE THAN $5000)
Jodie Ricci (Faculty & Non-Faculty Requests over $100)
Keven Krajnak (Advancement Office Requests over $500)
Athletics (Jason Baxter / Jodie Ricci) (ALL Athletics Requests)
Request does not meet authorization thresholds listed above
Signature (Use your mouse to sign)
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clear
Thank you for your submission.
For submissions between:
13th and 27th: Payment date will be the 1st.
28th and 12th: Payment date will be the 16th.