Payment Notice Form – draft

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

  • Amount for Notice
  • Name of vendor for payment notice
  • Purchase order number payment will be held against
  • Payment needs to be made by this date
    Date Format: MM slash DD slash YYYY
  • Requestor Information

  • 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.

Contact

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

Email: AP-Invoices@bussvc.wisc.edu