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California State University, Long BeachCalifornia State University, Long Beach

Direct Payment Request

General Instructions

  1. Review the Detailed Instructions for Direct Payment Form
  2. Complete the form and use the button below to display a printer friendly version.
  3. Print the "Printer Friendly Version" of the form.
  4. Return the completed form, receipts, and supporting documentation to:

    LBCMP - University Controller's Office - Accounts Payable, Foundation Building Suite 280 (MS-9901), 6300 State University Drive, Long Beach CA 90815-4680

    LBFDN/LB49R - Research Foundation - Accounts Payable, Foundation Building, Suite 332, 6300 State University Drive, Long Beach CA 90815-4680

Fields with * are required.

Request/Invoice Details

BUSINESS UNIT
  • LBCMP = Campus
  • LBFDN = Research Foundation
  • LB49R = Philanthropic Foundation
REQUEST DETAIL

(mm/dd/yy)

INVOICE DETAIL

(mm/dd/yy)

$

Payee/Vendor Information

*PAYEE/VENDOR TYPE

TAX FORM #204

PAYABLE TO

Chartfield Information

Amount Account Fund Dept ID Program Class Project
$
$
$
$
$ Payee Total

Justification and Special Request Information

Special Request Disposition

STATEMENT OF PAYEE/REQUESTER RESPONSIBILITIES

(If requesting employee or student reimbursement, his/her signature is required)

I certify that this expenditure is reasonable and necessary for the department's operations and the University's mission.

Payee/Requester Signature

STATEMENT OF APPROPRIATE ADMINISTRATOR/APPROVER RESPONSIBILITIES

I certify that the funds are available for this expenditure and that this expenditure is reasonable and necessary for the department's operations and the University's mission.

Appropriate Administrator/Approver Signature

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DETAILED INSTRUCTIONS

Request/Invoice Detail

BUSINESS UNIT (select one)
Check the box to identify the Entity you wish to make the payment. Indicate whether the Business unit is LBCMP (Campus or State), LBFDN (Research Foundation), or LB49R (Philanthropic Foundation)
Request Date
Input the date the Direct Payment form is being completed
Requesting Department
Input the name of the department requesting payment
Department Reference Number (optional)
Enter the department’s internal reference number
Division
Select the division

OTP - Office of the President

AA - Academic Affairs

ATH - Athletics

DAF - Administration and Finance

SS - Student Services

URD - University Relations and Development

Invoice Date
Enter the date of the invoice
Invoice #
If known, enter the invoice number
Invoice Amount
Enter the total amount due to the payee (including tax, shipping, etc.)

Payee/Vendor Information

Vendor ID#
Input the vendor ID assigned to the Vendor.
Payee Type (select one)
Indicate whether the payee is an Employee Campus, CSULB Student, Other type of vendor, Employee Foundation, Other State employee, Non CSULB Student, Non US Citizen. Payments made to Non US Citizens, require a Foreign National Information Form (FNIF) be submitted to Accounts Payable prior to payment. Payments made to foreign nationals may be: 1) Restricted by type of Visa and 2) may be subject to both Federal and State Tax withholding. Payments made to US Citizens who are not California residents may be subject to California State Income Tax Withholding. Note: All Foundation and University employees performing a service must be paid through payroll. Unless identified as an exception, all 'Other' must have a vendor 204 form attached or on file with Accounts Payable.
Tax Form #204
Indicate whether the Vendor Tax Form #204 is Attached, On File, or Not Applicable. A vendor 204 form must be on file with the Accounts Payable department for all vendors unless: 1) the payee is a CSULB student 2) the payee is a CSULB employee 3) the payee is being refunded monies previously collected by the campus. Examples of a refund: return of a deposit, payment for returned show tickets originally paid by check or cash, or a cancelled citation. Please note a vendor 204 form is a substitute W9.
Vendor 204 Not Applicable
Select the reason why the Vendor Tax Form #204 is not required. Vendor 204 forms are not required for refunds, return of deposits, CSULB employees, or CSULB students.
EMPL or Student ID
If the Payee is a CSULB student or employee the employee/student ID number must be provided.
Payable to
Enter the legal name of the vendor. This must match the name provided on the Vendor 204 form.
Remittance Address
Input the vendor’s mailing address

Example of Other State Employee where Request Does Not Require 204 Form Due To Refund of Deposit:

Sample Payee Vendor Information Section for Vendor Type as Other State Employee
    and 204 form not applicable due to it being a refund. Sample shows payee type, 204 form status, employee or 
  student ID and notes. The notes are regarding all Foundation and University employees peforming a service must be paid through
   payroll and that non-California residents are subject to a state income witholding.

Chartfield Justification and Special Requests

Chartfield Information
Input the amount due and the chartfields. You may breakdown the amount being paid by different chartfields. Use multiple lines if there is a separate amount, fund, Dept ID, program, class, or project number.
Justification or Purpose of Expenditure
Enter the justification or purpose of the expenditure. If a reimbursement, begin with "Reimbursement" see, below. The description should demonstrate the benefit to the educational mission of the University, or the justification as an expense of the Project.
Special Handling
Check the box to indicate Special Handling/Enclosures if additional supporting document(s) must be included with the check when mailed to the vendor.
Pick Up
For internal control reasons and as a standard procedure all checks will be sent out via regular US mail. If a valid reason can be demonstrated, such as the check must be included with a confidential mailing or must be presented in person to a government agency, pick- up may be arranged at the Controller’s Office. Use the space provided to indicate the name of the person authorized to pick-up the check, his/her telephone extension, and the reason for the pick-up. Reminder: Employees seeking reimbursements should be encouraged to sign-up for Direct Deposit with Accounts Payable. For information regarding Direct Deposit and the sign-up form, refer to Controller’s Office Procedures and Forms.
Signature Approval
Obtain appropriate signature approval from the department and grants office, if required. The responsibilities/signature section of the form must be completed. The person requesting the payment must be different from the Appropriate Administrator/Approver. If the Payee is a student or an employee seeking reimbursement, He/She must sign the form. The phone number of the requester, if different from the payee, is required in case Accounts Payable has any questions regarding the payment. For more information regarding approval, please refer to Delegation of Purchasing Authority Guideline

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