USC Clubs Request for Payment

Submit details receipts, invoices, or meeting minutes along with this completed form. One (1) new form for each request.
Use this form for club and council member and vendor payments. Please retain all original receipts until the reimbursement has been paid to ensure all documents are confirmed. Email clubs@westernusc.ca if you have any questions about submitting this request.

Today's Date: Today's Date: / MM / DD YYYY

Date of submission for the request
Your Name Your Name First Last
Your @uwo.ca Email

Enter your uwo.ca email only for club finance tracking purposes only.
Your Position
USC Club Name (Choose your club from the drop-down menu)

If your club starts with "Western", it might be the second name of your club in the drop-down menu, in alphabetical order.
USC account number

5-digit number found on the general ledger beside the club name.
Name of Event Proposal

Payments and reimbursement requests require an event proposal submission. If an event proposal has not been submitted, please submit one for review.
Date of Event (if it's a recurring event, please indicate date range)
Was the event proposal submitted and approved?

Was the event proposal submitted and approved? Yes In Process Event Proposal wasn't submitted

Reimbursement requests are subject to having a submitted event proposal that has been reviewed by the clubs staff. The event proposal must also include an event budget to ensure the club finances are updated.
Did the event proposal include an event budget?

Did the event proposal include an event budget? Yes No Don't know

The event budget is to ensure that expenditures are allocated for the event. If an event budget was not included, reimbursement payment will be delayed or not approved.
Issue to (legal name for reimbursement or company name for payment):

For finance purposes, please ensure that the legal name of the club member, service provider, or company has the correct information to accept the funds.
Issue in the Amount of: $ Dollars . Cents
Total amount of receipts or invoice total.
Is this a vendor or service provider payment?
(examples: bus, venue, catering, DJ, decorator, security, photographer, performer, hotel, merchandise supplier)
Vendor Invoice Number (quotes or estimates will not be processed)

Ensure that the invoice includes company name, date, invoice number, and HST registration number if taxed is charged.
Brief description of items purchased and its category for the event (eg. merch, decorations, food, etc.)

This description will be shown on the club's general ledger.
Signing officer signatures

Two signatures required. If you are a signing officer, you can't sign off on your own reimbursement.
Signing Officer #1 Signing Officer #1 First Last
Note, a signing officer cannot sign off on their own reimbursement.

Signing officers - President, VP Events, or VP Finance
Signing Officer #1 position
Signing Officer #1 UWO Email

UWO email ONLY
Signing Officer #1 Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Signing Officer #2 Signing Officer #2 First Last
Signing Officer #2 UWO Email

UWO email ONLY
Signing Office #2 position
Signing Officer #2 Signature (leave blank for second signature to sign if you are unable to sign at the same time)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Payment/Reimbursement Option

Payment/Reimbursement Option E-transfer (must have auto-deposit) Cheque Pickup (USC Main Office, Room 340 UCC) Cheque to be mailed (complete address below) Other (Purchase Order, UWO invoice, USC internal, wire transfer, credit card)

E-transfers must be set to auto-deposit for funds to go directly into their bank account.
E-transfer email address (no phone numbers)
Office Use: Payee sign on date of cheque pickup
Address (fill out only if cheque is to be mailed) Address (fill out only if cheque is to be mailed)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Upload complete receipts or invoices that correspond to the Request for Payment. Receipts must be clear and show company date, date of issue, and items purchased. High resolution images are preferred. Invoices are required as quotes cannot be processed. HST must be on the invoices. Partial receipts will not be accepted.

Receipts must be clear and show company date, date of issue, and items purchased. High resolution images are preferred.

USC Clubs Request for Payment

USC Clubs Request for Payment

Office Use: Payee sign on date of cheque pickup