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Accounts Payable Forms
 
Internet Service Provider/Cell Phone
Reimbursement Form
Accounts Payable
Tel No (818) 677-3472
Fax No: (818) 677-4581
Mail Drop: 8202
LINE
Please indicate the type of reimbursement you are requesting:
Home computer Internet access:
640250
$
(Monthly Fee) *
Personal cell phone use for campus business:
640220
$
(Monthly Fee) *
Equipment Reimbursement
640220
$
(One-Time Only)
Manufacturer Model
* THE DEPARTMENT WILL DETERMINE THE MONTHLY FEE
LINE
Employee Name: Employee Campus ID No:
Employee Address, City, State & Zip:
Employee Signature: ______________________________ Date: __________
LINE
This agreement is effective until the end of the fiscal year, or until the employee separation or transfer to another department; whichever occurs first. Please notify Accounts Payable, mail Drop 8202, promptly should the employee separate or transfer.

Payments will be made every two months and mailed to the employee's home address. Payments will be processed each August 30, October 31, December 20 (due to campus closure), February 28, April 30, and June 30.

* Required Fields:
* ACCOUNT:
* FUND:
* DEPT ID:
* PRGM:
CLASS:
PROJECT/GRANT:
REQ #:
 
Please Choose:
 

REQUIRED SIGNATURES:

Financial Manager Approval: __________________________________________________________________

Date: __________

Print Name:  
   
President or Appropriate Vice-President Approval: _______________________________________________
 Date: __________
Print Name:    


Please return this form to Accounts Payable, Mail Drop 8202