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Forms | AP-102 Form

AP-102STATE
PAYMENT AUTHORIZATION FORM

Please complete the following information as soon as the goods, or services related to the purchase order have been received. Payment can not be made to the vendor until the Accounting Office is specifically notified that the items have been received in good condition and that the items received meet the purpose of the related purchase order.

Most vendors require payment within 30 days. Failure to complete the form timely may result in a 'credit hold', which will effect the entire University's ability for future purchases.

PURCHASE ORDER INFORMATION LOG

Vendor Name: *

Purchase Order #: *
DATE RECEIVED: *

ITEM DESCRIPTION:

PAYMENT AUTHORIZATION
ACCEPTORS NAME:
PHONE #: *
EMAIL: *

WAS ORDER COMPLETE YES NO *

PROCESS PAYMENT YES NO

If no, please specify in box below.

If the shipment was received in part, or if anything was damaged, or there are ANY other discrepancies, please indicate in the following space, WHAT SHOULD NOT BE PAID at this time and specify WHY payment SHOULD NOT be made for each item. Payments will not exceed quantity, and/or price as stated on the purchase order.

*IF THE REQUIRED FIELDS ARE NOT COMPLETED, THE FORM WILL NOT BE FORWARDED TO THE ACCOUNTING OFFICE.

NOTE: Purchase order numbers can be located on ALL FUNDS. Please contact the Purchasing Office if you have not received your Purchase Order.

Click here for INSTRUCTIONS FOR PREPARATION OF FORM AP-102
Please click the Send Form button only once. If you do not see an acknowledgement right away, please wait two minutes before clicking Send Form again.    


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