Chapter Payment Request

PAS Chapter:

International Chapters

Please email Justin Ramirez directly regarding payment of funds to parties outside of the US.

Which source of funding are you using for this payment?

Chapter AccountPAS Program FundingCombination of Both

Chapter/Event Information

Chapter President:

Chapter President Email Address:

Name of Event:

Date of Event:

Amount to be paid from Chapter Account:

Amount to be paid from PAS Program Funding:

Payment Information

Are you requesting a reimbursement or direct payment to a vendor?
*Reimbursements require a receipt or paid invoice. Vendor payments require an invoice and completed W9, regardless of amount.

ReimbursementDirect Payment to a vendor

Please submit a W-9.
*You may also email your W-9 to accounting@pas.org if you do not wish to upload it at this time.

To download a blank W-9 form, please click here

Make check payable to:

PAS ChapterIndividual/Organization

Did your vendor provide an invoice?

YesNo

Please attach any invoice or receipt(s)

Invoice Information

Name of Event:

Date of Event:

Amount Due:

Brief Description of Service:

Payee Information

PAS Chapter:

Full Name:

Mail Payment to:

Full Name:

Vendor Name:

Address:

City:

Country:

State/Province:

State:

Provinces:

ZIP/Postal Code:

Phone Number:

Email Address:

Contact Information