Payment Request Form

Please use this form to request payment for individuals who are presenting or participating at an individual event. For independent contractors who will be performing work on an ongoing basis over an extended period of time, please use the independent contractor form. If you have questions about which form to use, please contact Jeremy Till.

Requestor Name

Name of the person requesting the payment.

Requestor Email Address

Payee Name

Payee Affiliation

Payee Email

Payment Amount

Funding Source (if known)

Please link to a chart string in Finjector, if possible.

Justification

Supporting Documents:

If payment is an honorarium for speaking, please upload event flier/announcement/agenda.
Maximum 3 files.
10 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx.