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: