Payee Certification Form (Formerly Form 21)

The following form is used to request payment for services or request reimbursement to non-employees. Payee Certification Form
Directions on using the form Open the Payee Certification form by clicking on the above link. Then choose save if you want to be able to save data for future payments.
  1. Completing the form yourself
    1. Complete Section A with information provided by the Payee. All questions must be answered.
    2. Leave Section B blank (signed form may be used for future payments)
    3. Print the form
    4. Have Payee sign Section C
    5. Go to Step C
  2. Payee completes form
    1. Complete Section A. All questions must be answered
    2. Sign Section C
    3. Go to Step C
  3. After the form is completed and signed
    1. Turn in to the Business Office
    2. Provide Payment Information (Section B) to Business Office Clerk
    3. Business office scans or copies original form
    4. Business office completes Section B
    5. Business office complets a DIV and sends all paperwork to Accounting Services

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Copyright © 2012 Indiana University-Purdue University Fort Wayne.
Send comments and corrections on this web site to Tim Heffron

Revised: August 7, 2012
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