Direct Payment Request
Fields with * are required.
- Review the Detailed Instructions for Direct Payment Form
- Complete the form and use the button below to display a printer friendly version.
- Print the "Printer Friendly Version" of the form.
- 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
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- 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
- 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.)
- 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
- Payable to
- Enter the legal name of the vendor. This must match the name provided on the Vendor
- 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:
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