ASSOCIATED STUDENTS, INC
2012-2013 CLUB ACCOUNT EXPENSE AUTHORIZATION
CLUB & ACCOUNT INFORMATION
DATE RECEIVED
Club Name: ___CLUB NAME____________ Account No.: __ACCT #_______ Date: ________________
ASI OFFICE
BILLING INFORMATION
Invoice Date: ____________
Invoice Number: _____________*IF PAYING A BILL, PUT INVOICE INFO H ERE
PAYEE INFORMATION
Name: ___________
Phone: _______________ *TH IS IS TO DESCRIBE TO WHOM THE CH ECK IS BEING WRITTEN
(A VENDOR OR AN INDIVIDUAL SEEKING REIMBURSEMENT)
*Be sure to attach the invoice you are paying if paying a bill directly or original
receipts if reimbursement needed.
DATE RECEIVED
Street Address:_________________________
AUXILIARY OFFICE
City: _________________________ State: ______ Zip: ___________
A valid address required for all payments.
Mark this box to have the check held for pick-up at Accounting Office
PURCHASE ORDER & SHIPPING INFORMATION
Are you requesting a purchase order? YES
NO
P.O. No.: ________________
SHIPPING INFORMATION:
*IGNORE IF NOT ISSUING A P.O.
Street Address: ___________________________________________________________________________
City: _________________________
State: ______
Zip: ___________
DESCRIPTION OF EXPENSE
TOTAL COST
DESCRIPTION (I.E. 5 BASEBALL BATS AT $6 EACH )
X
Y
TOTAL:
____X+Y________
SIGNATURES & APPROVALS
RECEIVED BY:
ASI Business Office: ___ASI OFFICE ___________________________________
Date Processed: ___________________
AUTHORIZED BY:
Club Officer (print): __STUDENT OFFICER ________ Club Officer (sign): __________________ Phone Number (required): ______________
Club Advisor (print): _CLUB ADVISOR ______________ Club Advisor (sign): ________________________ Phone Number (required): ______________
PROCESSED BY:
Accountant Signature: ___ASI ACCOUNTANT_________________
Date Processed: ___________________