Individual/Professional ServicesAuthorizationandPaymentRequestForm

INSTRUCTIONSFORFORM

Definition

An individual service providershall include individuals presentinglectures, speeches, seminars, workshops, and/or performances or providing other professional services for education or research projects.

Exclusions

This does not include staff, facultymembers orstudents at Texas Woman’s University. Theseindividuals mustbepaidthrough the Officeof Human Resources.

Applicability

These rulesapplytoallfunds. This form mayonlybeused forservices that meet the following criteria:

  • Individual is US CitizenorPermanent Resident Alien
  • Payments areequal to orless than$5000.00
  • Amount includes the serviceprovided andallexpenses

Approvals

Priortocontractingforservices,a completed Individual / Professional Services Authorization and Payment Request Form must include the followingsignatures designating approval:

  • Requestor
  • Account manager
  • Officeof Researchand Sponsored Programs (Grant accounts only, ifapplicable)

Payment

Payment for services shallbemadeafter serviceshavebeen rendered. Submit the followingto theProcurement Serviceswithin five (5)days after services arerendered:

  • Approved authorization and payment request form including payeesignature
  • Completed and signed W9 form
  • Completed and signed EFT agreement form (ifthat is the preferred method of payment).

Individual/ProfessionalServices AuthorizationandPaymentRequestForm

DEPARTMENT AND PAYEE INFORMATION

DEPARTMENTANDPAYEE INFORMATION

Department Name / Project Title, Event, or Course
Individual Payee Name / Social Security Number
Mailing Address
Email Address
US Citizen / Permanent Resident Alien / Nonresident Alien
Iftheindividual to behiredisa NonresidentAlien,specialproceduresarerequiredandthisformisnotapplicable.SeePaymentto anInternational
IndividualontheHumanResourceswebsite.Iftheindividual isa currentor previousemployeeof TWU, contactProcurement Services.

SERVICES AND EXPENSES

Dates of Service
Person or group of persons to receive services
University / Program's benefit from these services
Description of Services
Account Number / Amount / $
Account Number / Amount / $

SIGNATURES FOR AUTHORIZATION (ALL REQUIRED)

RequestedBy(printname) / Title

I certify that the above services are not available on a direct salary basis from staff members of TWU. I certify that this fee is appropriate considering the qualification of the above named individual, the name of the services performed, and the amount normally paid for such services.

Account Manager (print name)
Account ManagerSignature / Date
Office of Research & Sponsored Programs (if applicable) / Date

SIGNATURESOFPAYEE (INDIVIDUAL PROVIDING SERVICE)

I certify that I have completed the services as described above and request payment in the amount indicated above as payment in full for services rendered. I have furnished all information and documents necessary for TWU to comply with federal taxation andimmigration law.Taxpayer Identification Number and Certification (W-9)

Payee Signature / Date