Disbursement Form

Used to initiate payments for the following:

  • Personal Service Agreements
  • Refund/Reimbursement to individual(s) or a company
  • Payment for Services less than $5,000
  • Stipends/Honorariums
  • Membership/Subscription

  • √  Vendor Name/Address; Start and End Dates of Service/Subscriptions, Description of the Service and Total Amount Due.
  • √  Banner Index Budget Authority signature 
  • √  Documentation must not contain Personally Identifiable Information (ex: SSN).
  • √  Vendor invoice and/or applicable backup, such as itemized receipts for reimbursements attached to Disbursement Form.
  • √  Disbursement Form that contains multiple payees (ex: student stipends) requires a list attached with the name, address, Banner ID# or last four digits of the SS#, and dollar amount.
  • √  Email the disbursement, invoice and backup to ap@ccsu.edu
  • √  Verify Vendor provided current W-9 via secure ShareFile site