Payment Notice Form – draft – Inside Business Services

This form is used if an additional or installment payment needs to be processed. If you know the vendor will not invoice Accounts Payable you should use this form. Please fill out two weeks before payment is due.

If there is more that one payment required, please complete this form for each payment.

Please note if the check is to be sent to an address other than what is noted on the purchase order or if there is any other special handling required.

Payment Notice Information
Payment Amount*
Amount for Notice
Vendor name*
Name of vendor for payment notice
Purchase Order Number*
Purchase order number payment will be held against
Payment Date*
Payment needs to be made by this date
Date Format: MM slash DD slash YYYY
Requestor Information
Requestor Name*
First Last
Email*
Phone*
Additional Notes
Please note if the check is to be sent to an address other than what is noted on the purchase order or if there is any other special handling required.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact

Accounts Payable Department
21 N. Park St., Suite 5301
Madison, WI 53715

Email: AP-Invoices@bussvc.wisc.edu

Payment Notice Information

Requestor Information

Contact