NYU SSteinhaardt Exxpense Reimbursemeent Form
To be used
d to reconcile p
payments to huuman subjectss only. Use AP Worrkflow to recon
ncile all other ccash advances a
and for all otheer reimbursem
ment requests. C
Cash advancess should be ccleared within 60 days from tthe “end date”” specified on tthe Request forr Advance Form
m (ADV3000).
PAYEE IN
NFORMATION
1. PAYEE’S FULL NAM
ME (First Name, Middle Initial, Last Name) For Accounts Payable Use Only VENDOR NUMBER 2. HOME ADDRESS 3. ALTERNATE MAILING ADDRESS 6. UNIVERSITY ID 4. DEPARTMENT TO BE CHARGED 5. TEL. NUMBER AND CONTACT PERSON
N (if other than Payee) 7. DATE CASH ADVA
ANCE REQUESTED EXPENSE//ACCOUNT DETAILS
8. EXPENSE T
TYPE 9. AMOUNT TOTAL EXPENSES: 9a LESS NYU ADVANCE:*
9b TOTAL RECONCILIAT
TION:
9c ACCOUNT FUND 10. CHARTFIELD
ORG/DEPT PROGRAM $ 0.00
If amount in 9c is less tthan zero, please attachh a check payable to NYU
U $ 0.00
*NYU Advance: Referss only to any cash advan ce requested using ADV
V 3000 PROJECT TAX CODE 11. TOTAL AMOUNT
T RECONCILED (in wordss) 12. DESCRIPTION AN
ND BUSINESS PUPOSE O
OF EXPENSE(S) SIGNATUR
RES/APPROVALS
I, the Payee, cerrtify that the charg
ges reported here are correct and th
hat I am not claimiing reimbursemennt from other sourcces for the same.
SIGNATURE OF PAYE
EE EMAIL ADDRESS OFF PAYEE TEL. NUMBER DATE SIGNATURE OF APPROVER NAME OF APPROVER (print) TEL. NUMBER DATE Nov. 12, 2015