Request for Payment

The Request for Payment Form will utilized to collect requests to pay expenses incurred during the course of approved Special Olympics Utah business (includes vendors, reimbursements, etc.). The Head of Delegation (or representative) or approved party will submit this form 30 days prior to the payment due date (for vendor payments)or within 60 days of the purchase or by December 31 of the current calendar year, whichever is sooner (for reimbursements). For delegation expenses, an approved Delegation Purchase Request form must accompany this form. Please note that requests for payment received outside of the minimum timelines listed above or without an approved Delegation Purchase Report may not be processed.

Name of Area and Delegation (ex. North.Hawks, Metro.Herriman High, LETR)*

Head of Delegation (or Representative) or Approved Party Name*

Email*

Date of Completion*

Date

Is this item for payment or reimbursement?*

PaymentReimbursement

Description of expense please list the team name, Item of Purchase, and sport *

*note SOUT does not pay for invitational sports, Bowling and Snowshoeing

Amount Requested*

Name and Contact Information for Payee*

By entering your name below you are electronically signing this form and asserting that all information provided above is true to the best of your knowledge:*

Please attach receipt here or you may also submit using the following methods - Fax: 801.363.1524 Email: badell@sout.org Mail: 1400 South Foothill Dr Ste 238 Salt Lake City, UT 84108

Select File

*You must submit a receipt in order to receive payment/ reimbursement