Disbursement Voucher Instructions

Please follow the steps below to fill out a Disbursement Voucher Form.

  1. Pay To (Legal Name)- Use your full legal name. Do not fill in SS #.  Attach a W-9 if paying for services
  2. Mailing address - This is required before a check can be issued.
  3. Citizenship - Check one. (For Non-Resident Aliens, other paperwork may need to be filed. See the Business Office for details).
  4. Account - Your 12 digit account number is entered here. A form without an account number will NOT be accepted. A 12-digit account number includes fund, object code, and unit balance (format xx-xxxx-xxxxxx). For partial listings of accounts and objects, see the Business Office website.
  5. Amount - The amount of the check to be issued. Make sure to total up the request as well.
  6. Description - A detailed description of the check's purpose. Attach any documentation to back up the request for reimbursement. Requests for reimbursement of goods purchased must have the supporting receipts attached.
  7. Pickup/Delivery Information - This area tells the Accounts Payable Coordinator/clerk what to do with the check after processing has been completed. Mailing information must be complete. For pickups, include the date and who pick up the check. For U.S. Mail, nothing other than checking the box is required, as the Business Office will send the check to the mailing address above. If other services are requested, check Other and include detailed information for your request.
  8. Date - Date prepared by you.
  9. Authorized Signature - Only those individuals whose names have been given to the Business Office by the person responsible for the account may sign this form. Checks will not be processed for vouchers signed by unauthorized persons. Also, if the person authorized to sign out of an account is the recipient of the reimbursement, then the form needs to be signed by his/her supervisor or someone else with the authority to sign out of the account in question. In some instances, this person must be someone who has the same level of authority as the person seeking reimbursement. Example: One of the University Dean's wishes to be reimbursed from one of his/her accounts for expenses related to travel which he or she has the proper receipts for. The Dean cannot sign his/her own reimbursement form even though he/she is authorized to sign out of the account. The Dean's secretary has authorization to sign out of the account but he/she does not have the same level of authority as the Dean. So the Dean must have the form signed by an Associate Dean or someone higher up such as the University Provost or University Treasurer.
  10. For Business Office Use Only. (Items below this line will be filled in by the business office.)

NOTE: Please present the original of this form for payment. Copies may be retained for your records.

Any goods, which have an accompanying invoice, don't need to have a disbursement voucher form filled out. Put the 12 digit number and have an authorized signature placed on the invoice. Give the original form to the Business Office for payment. No invoice or voucher will be paid without a proper 12-digit account number or the proper authorization signature.

Please note that account numbers given with insufficient funding to support any payment request will not be processed, and will delay payment until sufficient information is provided. All invoices will be paid according to the terms of the invoice and be remitted to the address on the invoice unless otherwise requested.

Statements will not be accepted for payment unless all invoices or receipts are attached, and the correct information is provided for processing.

Checks will be available for pickup on the scheduled processing date set by the Business Office. Checks are issued after NOON on Tuesdays and Fridays, except for the summer hours when checks are issued at 11:00 a.m. Vouchers must be in by NOON on Thursdays for a check to be issued on a Tuesday and by NOON on Tuesdays for a check to be issued on a Friday. Please review our Accounts Payable Schedule for Disbursements page for detail about changes in the schedule.

For more information or questions on the Disbursement Voucher Process, contact the Business Office at (540) 458-8730