Departmental Payment Transfer Request Form

The Departmental Payment Transfer Request Form is utilized to apply a payment to charges that have been billed through the centralized billing system. The following information is needed to properly apply payments to the designated customer account(s) and charge(s).

Please allow one business day for your request to be processed.

 
1 Start 2 Complete
(Program, Grant, Gift, or Project Number)
Department Detail Number if needed on the transaction
The number of the selling agency that the charge is billed under that you would like to pay.
Why are you paying this charge(s)
Student, Employee, Regular (Non-Student/Employee)
Single Customer Payment Information
If you are attempting to pay a charge for a single customer, please complete the following information
U-Bill Ticket Number
The amount you want to pay on the charge
If you would like to provide backup documentation as to why you are covering a charge for this customer, please provide it here
Files must be less than 6 MB.
Allowed file types: jpg jpeg png tif pdf doc docx.
Multiple Customer Payments
Please provide the same information requested above for the Single Customer Payment in your excel file for each individual customer
Files must be less than 6 MB.
Allowed file types: xls xlsx csv.
Any additional information we should be aware of