Payment Authorization - Western Kentucky University
Accounts Payable Copy
 Business Office Use Only
Voucher No:________________________
count image
PAYEE Mailing Address
 Date: (MM/DD/YY)
Name:
 Department:
Street Address:
 Index No: Amt: $
Street Address, Line 2:
 Index No: Amt: $
City, State, and Zip:
 Index No: Amt: $
WKU ID Number:
 Total: $
Description - Date - Invoice No - Credit Memo - Commodity Code
Quantity
Unit
Unit Price
Total
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
VENDOR'S CERTIFICATION
I hereby certify that the commodities or services specified above have been furnished to Western Kentucky University, that the quality and prices conform to the proposal or contract; and that payment in whole or in part has been received. FIRM:______________________________________ SIGNED BY:_________________________________ DATE:______________________________________ NAME AND TITLE:____________________________
(Type or Print)
INSTRUCTIONS
1. Only one payee per document.
2. If invoice is not attached, vendor's certification must be signed, preferably by check payee.
3. Form W9 must be attached for payment to individuals and companies and services and awards.
4. Retain Departmental copy, send the other copies to Accounts Payable for payment. (Minimum 48 hrs prior to when check is needed.) 		  Total Amount: $
Less Discount: $
Net Amount: $
CERTIFICATION and AUTHORIZATION FOR PAYMENT
I hereby certify that the materials and/or services detailed in this document and attachment thereto have been received and inspected, that the quantities or services received were as stated herein and that the condition was satisfactory except as otherwise noted above.

_________________________________________________
Recommended for Payment by          Phone           Date

_________________________________________________
Approved by                        Date








Payment Authorization - Western Kentucky University
Accounts Payable Copy, Second Copy
 Business Office Use Only
Voucher No:________________________
image count
PAYEE Mailing Address
 Date: (MM/DD/YY)
Name:
 Department:
Street Address:
 Index No: Amt: $
Street Address, Line 2:
 Index No: Amt: $
City, State, and Zip:
 Index No: Amt: $
WKU ID Number:
 Total: $
Description - Date - Invoice No - Credit Memo - Commodity Code
Quantity
Unit
Unit Price
Total
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
VENDOR'S CERTIFICATION
I hereby certify that the commodities or services specified above have been furnished to Western Kentucky University, that the quality and prices conform to the proposal or contract; and that payment in whole or in part has been received. FIRM:______________________________________ SIGNED BY:_________________________________ DATE:______________________________________ NAME AND TITLE:____________________________
(Type or Print)
INSTRUCTIONS
1. Only one payee per document.
2. If invoice is not attached, vendor's certification must be signed, preferably by check payee.
3. Form W9 must be attached for payment to individuals and companies and services and awards.
4. Retain Departmental copy, send the other copies to Accounts Payable for payment. (Minimum 48 hrs prior to when check is needed.) 		  Total Amount: $
Less Discount: $
Net Amount: $
CERTIFICATION and AUTHORIZATION FOR PAYMENT
I hereby certify that the materials and/or services detailed in this document and attachment thereto have been received and inspected, that the quantities or services received were as stated herein and that the condition was satisfactory except as otherwise noted above.

_________________________________________________
Recommended for Payment by          Phone           Date

_________________________________________________
Approved by                        Date









Payment Authorization - Western Kentucky University
Departments Copy
 Business Office Use Only
Voucher No:________________________
count image
PAYEE Mailing Address
 Date: (MM/DD/YY)
Name:
 Department:
Street Address:
 Index No: Amt: $
Street Address, Line 2:
 Index No: Amt: $
City, State, and Zip:
 Index No: Amt: $
WKU ID Number:
 Total: $
Description - Date - Invoice No - Credit Memo - Commodity Code
Quantity
Unit
Unit Price
Total
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
VENDOR'S CERTIFICATION
I hereby certify that the commodities or services specified above have been furnished to Western Kentucky University, that the quality and prices conform to the proposal or contract; and that payment in whole or in part has been received. FIRM:______________________________________ SIGNED BY:_________________________________ DATE:______________________________________ NAME AND TITLE:____________________________
(Type or Print)
INSTRUCTIONS
1. Only one payee per document.
2. If invoice is not attached, vendor's certification must be signed, preferably by check payee.
3. Form W9 must be attached for payment to individuals and companies and services and awards.
4. Retain Departmental copy, send the other copies to Accounts Payable for payment. (Minimum 48 hrs prior to when check is needed.) 		  Total Amount: $
Less Discount: $
Net Amount: $
CERTIFICATION and AUTHORIZATION FOR PAYMENT
I hereby certify that the materials and/or services detailed in this document and attachment thereto have been received and inspected, that the quantities or services received were as stated herein and that the condition was satisfactory except as otherwise noted above.

_________________________________________________
Recommended for Payment by          Phone           Date

_________________________________________________
Approved by                        Date