Washington and Lee University
Disbursement Voucher
DTP: _______________________
Business Office Use Only
Pay To (Legal Name):
ID,SSN or EIN:
Mailing Address:
APT:
City:
St:
Zip:
Citizenship Status
Select One
U.S. Citizen
Resident Alien
Non-Resident*
*Proper immigration and IRS documents must be on file with the International Department and Business Office before any type of payment can be made.
Account
Amount
Describe fully and if applicable attach documentation:
-
-
-
-
-
-
-
-
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Total Amount: $
*Only the visible area of the textbox will be printed.
If more area is needed, please attach an external document.
Waiting Room
Pickup/Delivery Instructions:
Select One
Will Pick Up
Campus Mail
U.S. Mail
Other
When:
By Whom:
Name:
Campus Address:
Please specify:
*Only the visible area of the textbox will be printed.
Date:
Authorized Signature:
__________________________________________________
Name:
Phone Number:
xxx-xxx-xxxx
Please print out this form and Campus Mail to:
Business Office
Early Fielding Building #114
Please
Business Office Use Only:
ID# __________ AR Type __________ AR Code __________ Other ____________
