Qualtrics Survey | Qualtrics Experience Management

Email Address:

Submission Requester:

Club Sport Team:

Club Sport 5-digit Account Number (#00000):

Payment Description
(i.e. what this payment is for)

Payment Recipient:

Payment Recipient's Butler ID #
(if applicable)

Payment Recipient Mailing Address
(This Must be written on any documentation, if it not already listed)

Payment Recipient Email Address:

Total Payment Amount:

Please upload all necessary support documentation associated with your request for payment. This includes, but is not limited to:

Itemized Receipts
Invoices
Screenshots of Bank Statements (Payment Proof)
Federal W-9 (Business Payment)

Please insure that the Name, Mailing Address, and Purose are clearly written on documentation.

In order to ensure your payment is quickly processed, please chek that your documents are clear/visible. If you are submitting photos if your documentation, they must be taken in a well-lit area and the entire document must be captured.
(Please note, you can only upload one file per question. If you need to upload multiple items, please combine into one document.