Return to CSUN Homepage

University Accounts Receivable
ACCOUNTS RECEIVABLE
TEL NO: (818) 677-3474
FAX NO: (818) 677-2840
MAIL DROP: 8334
Department Request for Agency Invoice
LINE
TO: UNIVERSITY ACCOUNTS RECEIVABLE / UH 365 / PHONE: (818) 677-3474 / FAX: (818) 677-7878
Received From: Date: UAR Received: _____/_____/_____ By: ____________
Dept:
Phone:
Fax: Mail Drop:
LINE
I. Brief description of services provided:
II. Provide backup backup information and documentation as required:
(e.g. PAID INVOICES, SALARY/BENEFITS RECORDS, ANALYSES, SCHEDULES OF SERVICES PROVIDED, ETC.)
III. Name of department receiving revenue:
REQUIRED FIELDS:
ACCOUNT:
FUND:
DEPT ID:
PROGRAM:
CLASS:
PROJECT/GRANT:
AMOUNT:
LINE
Signature of Person Authorizing Request: Title: Date:

______________________________
______________________
_____________
Request approved by: (MAR, Director, Finance Mgr.) Title: Date:

______________________________
______________________
_____________
Request Prepared by: Title: Date:

______________________________
______________________
_____________
Dept:
Phone: Fax: Mail Drop:
LINE
IV. Name of Auxiliary to be billed:
REQUIRED FIELDS:
ACCOUNT:
FUND:
DEPT ID:
PROGRAM:
CLASS:
PROJECT/GRANT:
AMOUNT:
Description: PO No: Req No: Date:
Authorizing Person: Phone: Fax: Mail Drop:
Title: Contact:
LINE
V. Name of other agency to be billed:
Authorizing Person or P.O.: Address:
Contact:
 Address2:
Phone/Fax: City, State, Zip:
Invoice issued by: _____________________ Ext: _______________ Date: _____________ Invoice No: _____________