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

Pay a vendor / 3rd Party

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 (checks & direct deposits)

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

Vendor Bank Name

Vendor Email

Vendor Phone:

ABA / Routing Number

Account Number

Comments

Address to send payment check:

Upload of receipts, invoices, quotes and any other documents that back up payment request
Preferred file types is pdf but can accept any format

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 (checks & 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.