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