Income Fund Reimbursable - Invoice Change Notice

Project Director: Date:

Campus Address:
Account Number:

Invoice Number:

Original Amount Due $

Adjustment Increase (+) $

Adjustment Decrease (-) $

New Total Due for this Invoice $

Reason for Adjustment (explain below):
* * * * * * * * * * * * *
Accounting Office Use Only: (all 4 copies of this form should be sent to the Accounting Office)

____ Adjustment Approved
____ Adjustment Disapproved (Explanation: _______________________)

Distribution
White - Issuing Office / Yellow - Issuing Office / Pink - Accounting Office / Goldenrod - Bursar's Office

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Project Director:	Date:
Campus Address:	Account Number:
Campus Address:	Invoice Number:

Original Amount Due	$

Adjustment Increase (+)	$
Adjustment Decrease (-)	$
New Total Due for this Invoice	$