Departmental Payment Transfer Request Form

Name of Requester*

Requester's Email*

Requester's Phone*

Workday Driver Worktag*

(Program, Grant, Gift, or Project Number)

Department Detail

Department Detail Number if needed on the transaction

Selling Agency Number

The number of the selling agency that the charge is billed under that you would like to pay.

Business Purpose*

Why are you paying this charge(s)?

Customer Type*

Student, Employee, Regular (Non-Sudent/Employee)

Single Customer Payment Information

Customer Name

Customer Account Number

University Receivable's Customer Number

Invoice Number

U-Bill Ticket Number

Amount to Pay

The amount you want to pay on the charge.

Single Payment Documentation

If you would like ot provide backup documentation as to why you are covering a charge for this customer, please provide it here.
Files must be less than 6MB.
Allowed file Types: jpg, jpeg, png, tif, pdf, doc, docx.
One file only.
6 MB limit.
Allowed types: jpg, jpeg, png, tif, pdf, doc, docx.

If you are attempting to pay a charge for a single customer, please complete the following information.

Multiple Customer Payments

File Upload

If you would like ot provide backup documentation as to why you are covering a charge for this customer, please provide it here.
Files must be less than 6MB.
Allowed file Types: xls, xlsx.
One file only.
6 MB limit.
Allowed types: xls, xlsx.

Pleas provide the same information requested above for the Single Customer Payment in your excel file for each individual customer.

Additional Information

Any additional information that we should be aware of.