Payment Request Form

Fill out this form in order to request a payment voucher for purchase of goods or services, or for reimbursement for a previous purchase of goods or services. Prepared vouchers will need to be signed by an officer; if the payment is to a club officer the voucher must be signed be an officer other than that student. Please ensure you email an invoice to sportclubs@uta.edu if applicable.

Please select your club: *
What is the date the payment is needed to be completed? What is the date the payment is needed to be completed? * / MM / DD YYYY
What is the amount of the requested payment? *
Provide a brief description for the payment: *
Will this come out of the State (47) account or the Club (92) account? *

Will this come out of the State (47) account or the Club (92) account? State (47) Account (Typically Enterprise rentals, entry fees, equipment and supplies) Club (92) Account (Everything else, including reimbursements)
Can this payment be made via credit card? *

Can this payment be made via credit card? Yes No
If yes, please include a link to online payment or other instruction to make payment.
To whom is this payment going to be made? *

To whom is this payment going to be made? Student Non-Student or Business
Payments to a Student
Name of Student to be Paid:
Above Student's ID#:
Contact Phone Number: Contact Phone Number: - ### - ### ####
Payments to a Non-Student or Business
Name of Non-Student or Business to be Paid:
Street Address:
City & State
Zip Code:
Contact Phone Number: Contact Phone Number: - ### - ### ####
PLEASE UPLOAD YOUR RECEIPT/INVOICE TO BE PAID BELOW:

Thank you.
Receipt/Invoice upload

Attach Files
Final Artwork Approval upload

Attach Files
Email Address: *
Click submit below to complete the request.

Payment Request Form

Payment Request Form

Payments to a Student

Payments to a Non-Student or Business

PLEASE UPLOAD YOUR RECEIPT/INVOICE TO BE PAID BELOW: Thank you.

Click submit below to complete the request.

PLEASE UPLOAD YOUR RECEIPT/INVOICE TO BE PAID BELOW:

Thank you.