Check One         DIRECT PAY COVER SHEET
           EMPLOYEE REIMBURSEMENT REV'D 2-13-02
   
           OTHER REIMBURSEMENT
   BANNER DOCUMENT NUMBER TRANSACTION         VENDOR INVOICE
   (CAPITAL I, ZERO, SIX DIGITS) DATE        MISCELLANEOUS PAYMENT
       
       
   PAYEE AUTHORIZED APPROVER SIGNATURE DATE
       
       
   AMOUNT FUND - ORG - ACCOUNT - LOCATION PICKUP CODE
     
     
   DEPARTMENT USER DEFINED
     
     
   RESPONSIBLE PARTY USER DEFINED
       
       
   EMAIL ADDRESS PHONE EXT USER DEFINED
  = REQUIRED ENTRY                
   COMMENTS:
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