Accounts Payable Forms	Accounts Payable Tel No (818) 677-3472 Fax No: (818) 677-4581 Mail Drop: 8202
	Direct Payment Encumbrance Form JUNE 2007 EXPENSES ONLY

This form is used to encumber anticipated June 2007 direct payment expenses. Submit this form to Accounts Payable, mail drop 8202, by close of business on 06/28/2007. If you have any questions regarding this form, please contact the Accounts Payable staff at extension 3472. NO FAXES PLEASE.

REQUIRED FIELDS:	ACCOUNT:	FUND:	DEPT ID:	PRGM:	CLASS:	PROJECT/GRANT:	REQ #:

Vendor Name:
Expenditure Amount:
Description:
Date of Anticipated Expense:

Approving Officer Signature:___________________________________________
Print Name: ___________________________________________
Date: _________________

~ OFFICE USE ONLY ~
Prepared By:	Extension:	Department: