EmailMe Form - MPI MN - Credit Card Request Form

This form is used when requesting to pay a bill/invoice using the MPI credit card.

Submit this form and upload applicable documents (e.g. receipts, invoices and/or contracts).

The credit card will only be used once approval is granted by the Vice President or Director of Strategic Alliances or a member of the Office of the President.

After you submit this form, you will receive an email confirmation and it will be emailed to Strategic Alliances for approval to the Chapter Administrator.

Check Request Number

Fiscal Year *

Today's Date

MM / DD / YYYY

Requestor Name: *

First Last

Requestor Email Address *

Pre-Approval *

President (Clint Greenebaum)

President-Elect (Savannah Fargen)

Immediate Past President (Elizabeth Sherry)

VP, Strategic Alliances (Lisa Albers)

Director, Strategic Alliances (Lisa Anne Venne)

In order to use the Chapter credit card, the requestor must have pre-approval from one of the above Officers.

Payee Information

Payee Name

First Last

Or
Company Name

Payee Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Charge Amount *

$ Dollars . Cents

When do you need this charge made?

MM / DD / YYYY

The Chapter pays the majority of its bills via checks, cut once per month. These charges will be made within 2 business days of Board approval.

Additional Instructions:

Please provide instructions about how/where to make this charge. For example, is there a phone number and confirmation numbers for the hotel reservation?

Upload W-9

Payment will NOT be issued until this has been provided/is on file for the current calendar year.

To make year-end financials as easy as possible, please make sure MPI has a copy of this payee's W-9. If you're not sure, upload it anyway.

To get a blank W9, click here

To make year-end financials as easy as possible, please make sure MPI has a copy of this payee's W-9. If you're not sure, upload it anyway.

FFI: Form W-9 is used by persons/organizations required to file information returns with the IRS to get the payee's correct name and TIN. For individuals, the TIN is generally a social security number (SSN).

Accounting Information

What is this payment for? *

Please specify the event or program name and date so we can ensure accounting codes are correct.

If the check requested has more than two sets of codes associated (see below), indicate those additional amounts and the corresponding codes in the text box above.

Committee Code *

After you select a committee code, the corresponding set of expense codes will pop up. These codes are based on what is in the Board-approved budget. If you think a code is missing, please note that in the text box above.

Expense Code (for 100)

Expense Code (for 200)

Expense Code (for 240)

Expense Code (for 300)

Expense Code (for 410)

Expense Code (for 440)

Expense Code (for 610)

Expense Code (for 900)

Upload Invoice(s) or Receipt(s)

You can upload multiple attachments.

After you submit this form, you will receive an email confirmation and it will be emailed to Strategic Alliances for approval.