Finance VR Request Form

FINANCE VR REQUEST FORM

Request Summary

VR Request No.:     Request Date:     Priority:

Requestor / Department

Payee / Vendor Information

Vendor Tax ID / EIN:     Vendor Contact:

Payment Details & Itemization

Currency:     Requested Payment Date:     Payment Terms:

Subtotal:     Tax:     Shipping/Other:     Total:

General Ledger / Cost Allocation

Allocate amounts to GL accounts. Provide full account code and amount for each line.

Payment Method & Instructions

Select preferred payment method. Final method determined by Finance subject to compliance and vendor setup.

ACH / Direct Deposit    Wire Transfer    Paper Check    Corporate Card Payment

Supporting Documentation

Indicate attachments and describe supporting documentation. Originals must be retained per policy.

Certifications & Representations

By submitting this Finance VR Request Form, the Requestor certifies that the information provided is true, complete and accurate to the best of their knowledge; that the requested payment is for legitimate business purposes; and that the expense complies with applicable company policies and authorizations. The Requestor acknowledges that submitting false claims or misrepresentations may result in disciplinary action, restitution, or other remedies permitted by law.

The Requestor further authorizes Finance to make necessary tax reporting determinations and to withhold or deduct taxes where required by law. Vendor setup and payment will be completed only after vendor validation and any required withholding documentation is received.

Approvals (Administrative)

Manager Approval:     Approved?    Date:

Finance Reviewer:     Reviewed?    Date:

Additional Terms

Payment will be made in accordance with established payment cycles and vendor setup status. Late submissions may be subject to delay. Any dispute over amounts must be raised in writing within 30 days of payment. Requests involving third-party reimbursements may require additional documentation and approvals.

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