OGPC Payment Requisition Form (blue sheet)

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This field is for validation purposes and should be left unchanged.
Upload your receipt(s) here
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Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB, Max. files: 4.
MAKE CHECK PAYABLE TO:*
Today’s Date
ADDRESS (if not on invoice)
REASON FOR CHECK
SPECIAL INSTRUCTIONS
1099 Payment?
- No
- Yes
Account #*
Account Name*
Amount*
Account #
Account Name
Amount
Account #
Account Name
Amount
Account #
Account Name
Amount
TOTAL AMOUNT PAYABLE*
Please note: We need two co-signers if the amount is over $5,000. Either your second committee signer must submit an online blue sheet, or you should fill out the paper copy with both signatures.
Your Email Address*
Committee Chair Authorizing this Request*
Authorized Signature*