PAYMENT REQUISITION FORM
Henry S. West Lab PTO, Inc.

Note: Prior to completing this requisition form, please ensure your reimbursement, advance or invoice is part of a project budget that has been approved by the PTO Board.

Program / Committee *

Date

Requestor Name: *

Requestor Phone: *

Email: *

Payment Type
(Check one box)
*

Reimbursement

Amount: *

Payment Options:

All payments for vendor services must be paid directly by the PTO to the service provider.

ALL PAYMENTS ARE PAID BY BILL.COM (we ONLY use ACH direct deposits)

Make check payable to / Vendor Name / Name in Bank Account: *

Vendor Bank Name

ABA / Routing Number *

Account Number *

Comments

Upload of receipts, invoices, quotes and any other documents that back up payment request
Only file types accepted are pdf, doc, docx, ppt, pptx, jpg, jpeg, png, xls & xlsx.

Document 1

Document 2

Document 3

Document 4

Document 5

Document 6

Approver *

Comments

Status *

Approved

Denied

To be modified

* = Input is required

PAYMENT REQUISITION FORM Henry S. West Lab PTO, Inc.

**All payments for vendor services must be paid directly by the PTO to the service provider.**

ALL PAYMENTS ARE PAID BY BILL.COM (we ONLY use ACH direct deposits)

PAYMENT REQUISITION FORM
Henry S. West Lab PTO, Inc.

All payments for vendor services must be paid directly by the PTO to the service provider.