Check Request Forms UoW 1570 and UoW 1571

• Check Request Form UoW 1570 (pdf)
• What may be paid on Check Request forms
• How to fill out Form UoW 1570
• Multiple Check Request Form UoW 1571 (pdf)
• How to fill out Form UoW 1571

The check request form is used for payments to individuals for amounts of $3,000 or less. See Payments to Individuals for full information on the check request process.

Payments to individuals includes:

• Honorariums
• Reimbursements for miscellaneous purchases of merchandise or supplies for University use
• Travel reimbursements related to Honoraria
• Payments to student performers
• Payments for prizes, awards to non-University students, royalties, permission fees, copyrights

• Contracts
• Reverse expenditures
• Personal services must be submitted on a . Examples of personal services include but are not limited to the following:
• Consulting
• Editing
• Design services
• Programming
• Collaborative research
• Analyzing
• Reorganizing
• Payments an individual makes to research subjects (individual should request a field advance or a petty cash revolving fund)
• Payments an individual makes to a third party for personal services
• Rental of equipment or purchases of equipment over $2,000
• Refunds from revenue budgets (should be submitted on Refund Check Request Form UoW 1768)
• Prizes, awards and gift certificates for UW employees and UW students (should be submitted through Payroll and Student Fiscal Services)
• Travel Expenses not related to an honorarium
• Moving Expenses
• Housing

Filling out the Form

The Check Request form is available on the Web and through University Stores. Please print the WEB form on white paper to ensure readability and proper processing. Legibility is essential for proper data entry.

(If you have difficulty printing the Web form, it could be that your printer needs its memory upgraded. Insufficient buffers are the main cause of forms not printing as displayed.) In the interim, please contact University Stores and request form number UoW1570. This form is free.

• VENDOR CODE - Payables Administration use only.
• REASON FOR PAYMENT - Required. Check the appropriate box
• Reimbursement (Attachments Required) - original receipts showing proof of payment must be provided
• Honorarium - Payments to non-UW employees for specific services (i.e. lecturers, performers). Cannot be used to pay contracts. PO's are required for contracts.
• Other - must provide appropriate explanation. May include payments to research subjects, prizes, awards for non-UW students, student performers, royalties, permission fees, copyrights.


• SERVICE DATE OR PERIOD - Required field for Honorariums and Research Subjects. Can designate range of dates or final date of service.
• DEPARTMENT NAME - Required field. Name of Department (and Unit if necessary) requesting check.
• DEPARTMENT CONTACT - Required field. UW Employee preparing the documents.
• DEPARTMENT PHONE - Required field. Phone number of the Department Contact.
• TECH CONTACT - Required field. UW Employee with knowledge of actual transaction.
• TECH PHONE - Required field.
• BOX NUMBER - Required field. Current campus mail stop.
• STATUS - Required.
  • U.S. CITIZEN - native born or naturalized
  • NON-RESIDENT ALIEN - temporary visitor from another country. Copies of documentation needed. See NRA website for more information.
  • RESIDENT ALIEN - Permanent Resident (non-U.S. citizen) working and living in the United States. This individual is usually referred to as a "green card holder".
  
  
• U.S. TAXPAYER ID NUMBER - Required for Honorariums, services, consulting fees, lecturers, rent, repairs and maintenance, copyrights, royalties, permission fees, prizes and awards, healthcare providers, and attorneys. This number will be a Social Security Number (SSN); Employer Identification Number (EIN) if paid to a sole proprietorship or partnership; or Individual Taxpayer Identification Number (ITIN) in the case of non-resident alien individuals.
• 1099 TYPE - Payables Administration use
• VENDOR NAME & PERMANENT ADDRESS - fields 1, 2, 3, 4 and 5b are limited to 40 characters, including spaces.
  • 1. VENDOR CLAIMANT NAME - full legal name of recipient as registered (person or company) with the Internal Revenue Service or the Social Security Administration. The first name of an individual should appear first on the line. Do not include nicknames, titles or formalities (such as Mr. Mrs. Dr. etc) with the name. Do not put any part of the name in parentheses. Do not use initials (should be written John D. Doe not J.D. Doe).
  • 2. (Use this field if name in line one is over 40 characters long.)
  • 3. PERMANENT ADDRESS - should be home address of the payee or personal PO Box.(No UW addresses.)
  • 4. Use for second line of address. Also used for City, State, County, Province and Postal Codes for Foreign vendors.
  • 5a. CITY, STATE, ZIP - Use for US vendor addresses only. (Use line 4 for Foreign city information.)(City can be no more than 28 characters long.)
  • 5b. COUNTRY (Foreign) - Use only for foreign vendors
  
  
• VENDOR'S CERTIFICATE - Required on Reimbursements only. The department is responsible for obtaining the signature of the individual being reimbursed.
• CHECK HANDLING INSTRUCTIONS - Required. Check appropriate box. Partial or full payments requested in advance of the service ending date must be marked either Hold for Pick-up or Sent to Department. If not indicated the check will be sent to the department for distribution.
  • MAIL TO PERMANENT ADDRESS - check will be sent to address in section 13.
  • HOLD FOR PICK-UP:
    • CALL - provide first and last name of individual to be called when check is ready.
    • PHONE - provide full phone number of the individual requesting the pick up.
  • SENT TO:
    • 3. C/O - Provide name or department to where the check should be sent
    • 4. BOX - University mail-stop
  
  
• SPECIAL INSTRUCTIONS - Use only to provide Payables Administration with instructions not covered in Check Handling Instructions (i.e. Wire Transfer, foreign currency, UPS, Courier pick-up, overnight express).
• DETAILED DESCRIPTION - Required. Describe what was purchased or what service was performed. Describe when the purchase was made or the when the activity took place. Describe where the purchase was made or where the activity took place, and an itemization of the expenditure including extension of quantity x price or the amount to be paid for the activity. Reimbursement of Entertainment must include name of all persons attending affair and what was the purpose of the meeting. If a reimbursement of Travel related to an Honorarium includes meals, the meals must be itemized. Only one line is allowed for Quantity, Unit and Unit Price. The Extended Amount is calculated automatically on the on-line form.
• SUBTOTAL - Required. Total of all items listed in Detail Description. (Automatically calculated on on-line form.)
• LESS W/H - Payables Administration use only. Taxes deducted under certain conditions (i.e. tax id missing, NRA payments when required by law).
• CHECK AMOUNT - Payables Administration use only. Subtotal less any withholding.
• ACCOUNTING DETAIL - Required. Requesting department must provide all accounting information necessary to record the payment properly. If more than one budget or object code is used, department must provide breakdown. The form only allows for five lines of accounting detail. If you need additional lines, consider splitting the request into two or more parts or you may fill out two check request forms with the same reference number.
  • BUDGET NUMBER - Six digits only (##-####)
  • OBJ/SUB/SSUB - Two digits per field (## - ## - ##)
  • TASK, OPTN, PROJECT - Optional. Use only as needed.
  • USE TAX - Payables Administration use. The State of Washington requires us to assess taxes on purchases made from vendors which do not collect sales tax for the State. If a receipt does not show that sales tax was charged, we are required to calculate and pay the tax to the State. This will result in a higher amount appearing on your BAR than was actually paid to the payee.
  • AMOUNT - If paying in foreign currency, do not fill this in. Foreign currency conversion will be provided by Payables Administration based on the value of the currency when purchased through our service agent.
  • INVOICE/REFERENCE NUMBER - Required. Requesting Department must provide a unique reference number for each check request. This number is necessary as a reference on the BAR and as a tracking device for Payables Administrations document logging.
  • DATE PREPARED - Required.
  • Shaded Accounting line - Payables Administration use only to record withholding for tax purposes.
  
  
• PREPARER'S SIGNATURE - Recommended. While it is required that the authorized official sign this document, it is strongly recommended that a separate individual prepare the document in order to guard against fraud.
• DATE SIGNED - Required if signed by a preparer. Date paperwork was completed.
• AUTHORIZING OFFICIAL'S SIGNATURE - Required. Signature of person in the department with budget authority.
• DATE APPROVED - Required
• CHECK NUMBER - Payables Administration use only
• CHECK DATE - Payables Administration use only

When to use this form

You may not use this form for payments to Non-resident Aliens (NRAs). Non-resident Aliens should always be processed individually because of reporting issues.

Checks may be picked up, sent to a campus address or mailed directly to the individual.

Filling out the Form

This form is available online. Information filled in on page one that is repeated on pages 2 through 5 will automatically be filled in by the program. Pages are totaled automatically.

The TAB key moves you from field to field. Use the ENTER key by the keyboard (not the ten-key enter key) to move down in a field such as the name and address field or the Check Handling Instructions field.

• REASON FOR PAYMENT - Required. An explanation of why the payments are being made (i.e., Research Subjects).
• SERVICE DATE OR PERIOD - Required. Date or period of time covered by the payments.
• DEPARTMENT - Required. Name of department requesting payment.
• DEPARTMENT CONTACT - Required. Name of person Payables Administration can contact, if needed.
• DEPARTMENT PHONE - Required. Phone number of Department Contact.
• BOX NUMBER - Required. Campus mailbox for department.
• STATUS - Required. Please mark appropriate box(es). U.S. Citizens and Resident Aliens may be included on the same multiple check request form. Non-Resident Aliens (NRA's) cannot be paid on this form.
  • U.S. CITIZEN - Native born or naturalized
  • RESIDENT ALIEN - Permanent Resident (non-U.S. citizen) working and living in the United States. This individual is usually referred to as a "green card holder".
  
  
• PREPARER'S SIGNATURE - Recommended. While it is required that the authorized official sign this document, it is strongly recommended that a separate individual prepare the document in order to guard against fraud.
• DATE SIGNED - Required if signed by a preparer. Date paperwork was completed.
• AUTHORIZING OFFICIAL'S SIGNATURE - Required. Signature of person who has budget approval.
• DATE APPROVED - Required. Date approval was made.
• CHECK HANDLING INSTRUCTIONS - Required. Check appropriate box.
  • MAIL TO PERMANENT ADDRESS - Mark this box if you wish all checks to be mailed to the payees.
  • HOLD FOR PICK-UP:
    • PHONE - Phone number of above person
    • CALL - Name of person to be called when checks are ready
  • SEND TO:
    • 3. C/O - Name of person to whom the checks should be sent
    • 4. BOX - Campus mail stop for c/o person
  
  
• INVOICE NUMBER - Required. Identifier assigned by the department to appear as reference on the BAR. This number is also used to help the Payman team track the document. Unlike individual form, all payments on this form will have same reference number.
• INVOICE DATE - Required. Date form is completed.
• BUDGET NUMBER - Required. Budget to be charged must be same for all payees on form.
• OBJECT CODE - Required. Expenditure code to be charged must be same for all payees on form.
• VENDOR NUMBER - Optional. Some payees may have been assigned vendor numbers in the vendor control file. If the department is aware of the number it may fill in this information. It is an eight-digit number. If a vendor number is used, the payee must not be included on a form with payees who do not have vendor numbers.
• U.S. TAXPAYER ID NUMBER - Required for any payment made that is reportable to the Internal Revenue Service (IRS) (i.e., Honorariums, Research Subjects). This number is the person's Social Security Number (SSN). If an EIN is used, use form UoW 1570. Please key Social Security Number as ###-##-####.
• 1099 TYPE - (Fin. Svc. use only) - This is filled in by Payables Administration during processing.
• Name and Permanent address
  • 1. NAME AS RECORDED WITH IRS OR SOCIAL SECURITY - Required. This must be the legal registered name of the payee. Do not use nicknames, titles or formalities such as Mr., Mrs., Dr., etc.
  • 3. PERMANENT ADDRESS - Required. Permanent street address of payee
  • 4. PERMANENT ADDRESS (FOREIGN CITY AND ZIP) (or Postal Code) - Used as additional address line of payee for U.S. addresses and for the city and zip of addresses in foreign countries. Zip or Postal Codes are required for Canada, United Kingdom and Australia. Payees with a foreign address must be on a separate form from those with U.S. addresses.
  • 5. CITY, STATE AND ZIP CODE (FOREIGN COUNTRY) - Required. Used for city, state and zip code on U.S. addresses and for the name of the foreign country if payee resides outside the U.S. Payees with a foreign address must be on a separate form from those with U.S. addresses.
  
  
• U.S. DOLLAR AMOUNT - Required. An amount must be filled in for each payee. Do not use dittos. System will add cents (.00) for whole dollars only when you leave the field. Please verify that the system shows both dollars and cents before printing form.
• LIQ. CODE - Required. This is always N.
• TOTAL - Automatically calculated by the system when you exit the U.S. Dollar Amount field.

Financial Services
A Department of Financial Management
Modified: May 5, 2007