Spreadsheet: 23c72908-e824-498c-9b47-abfbce044618
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29
 |  |  | Southern Methodist University
 |  |  | PAYMENT REQUEST |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Check Number
 |  |  |  |  | ACCOUNTS PAYABLE, BOX 162 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (For AP use only)
 | PO Number |  | Final Payment |  |  |  |  | Date Due |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Help with form
 | Vendor ID/code |  | Address Code |  |  |  |  |  | Invoice Number |  |  |  |  |  |  |  |  |  |  |  |  | Invoice Date/Service Date or Period
 | Payee Legal Name (Individuals should include full first , last name and middle initial) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Payment Handling Instructions:  Payment  will be made to payee via direct deposit(ACH) or EFT if account information is on file. Otherwise indicate below.
 | SMU ID |  |  |  |  |  |  |  | Country (Foreign)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Mail check to Permanent Address
 | Permanent Address
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Mail check with Attachments
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Hold check for Pick-up Call Ext
 | City |  |  |  |  |  |  | State |  |  |  | Zip
 | Reason for Payment |  |  |  |  |  |  |  |  |  |  |  |  | Purpose of payment (information only; does not appear in GL detail)
 |  | Reimbursement (attachment required)
 |  | [NAME] (Provide details in Purpose of Payment)
 |  | Other
 |  | Invoice attached
 | Department Name |  |  |  |  |  |  |  |  | Department Contact |  |  |  |  |  |  |  |  |  |  |  |  | Department Phone
 | Preparer's Name |  |  |  |  |  | Ext. |  |  | Authorized by (Financial Officer) |  |  |  |  |  |  |  |  |  |  |  |  | Date
 | US Tax Residency Status |  |  |  | Privacy Act Notice: IRC Sections 6109 requires most recipients for services performed to give taxpayer identification numbers to payers who must report the payments to IRS. IRS uses the numbers for identification purposes. Payers must be given the numbers whether or not recipients are required to file tax returns. Payers must generally withhold taxes from taxable payments to a payee who does not furnish a taxpayer identification number to a payer. Certain penalties also apply. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | U.S. Taxpayer ID Number |  |  |  |  |  |  |  | W9 Form
 |  | U.S. Citizen |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (for foreign persons only)
 |  | Resident Alien |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Attached
 |  | Foreign National |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | On file
 | Distribution
 | Description (appears in GL detail) |  |  |  |  | Amount |  |  |  |  |  |  |  |  | Acct (4) |  |  |  | Fund (2) |  | Org (6) |  |  |  | Subclass (5) |  |  | Project (7)
 | Total Payment Amount |  |  |  |  | 0
 | Special Approvals (Request must be signed by someone authorized to charge against the organization ID's Referenced above)
 | Typed or Printed Name |  |  |  |  |  |  | Signature |  |  |  |  |  |  |  |  |  |  |  |  |  | Title |  |  |  |  | Date
 | Typed or Printed Name |  |  |  |  |  |  | Signature |  |  |  |  |  |  |  |  |  |  |  |  |  | Title |  |  |  |  | Date
 | Typed or Printed Name |  |  |  |  |  |  | Signature |  |  |  |  |  |  |  |  |  |  |  |  |  | Title |  |  |  |  | Date
 | Typed or Printed Name |  |  |  |  |  |  | Signature |  |  |  |  |  |  |  |  |  |  |  |  |  | Title |  |  |  |  | Date