Form 10: Special Remittance and Order Form

Form 10: Special Remittance and Order Form
Form 10 Checklist | Click here for online help.

Send a form duplicate to the Accounting Office in lieu of requisition only when remittance in advance is required, and it is impossible to obtain an invoice. Please attach any additional copies to accompany check if needed.

Date: Amount of Request $ (Automatically Computed)

Payable To: (First/Last Name and Address of Vendor) Banner UID:

Prepared By (Please Print)

Email/Ext

Quantity and Unit Price values must be filled in; the Subtotal and Total values will automatically compute.

Quantity (Required)	Description	Unit Price (Required)	Subtotal












TOTAL

Check this box if you want the Accounting Office to hold check for pickup.
Contact Name_________________________________ Phone ______________

Deliver Merchandise To:
The University of Memphis
Dept:
Address:
Memphis, TN 38152-
Departmental Phone Number (use 7 digits):
(901)

Index #/Account Code:

Name of Approver:

_________________________________
Signature of Approver Date

The University of Memphis is an Equal Opportunity/Affirmative Action University.
It is committed to education of non-racially identifiable student body.