Mu Phi Epsilon Payment Request

Submit this form and upload all applicable receipts or invoices.

After you submit this form, you will receive an email confirmation and it will be emailed to the Synergos finance department for processing.

Payment Request Number

Requestor Name: *

First Last

Requestor Email Address *

Payee Information

Payee Type *

Pay Company

Pay Individual (Check)

E-payment (ACH)

Transaction Date *

MM / DD / YYYY

Payee Company Name

Payee Individual Name *

First Last

Payee Address *

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

Total Amount *

$ Dollars . Cents

Additional Instructions:

If no information is provided above, the check will be mailed via US Mail, to the payee.

Accounting Information

Please note that the Mu Phi Epsilon mileage reimbursement rate for 2023 is $0.40 per mile.

What is this payment for? *

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

Expense Accounting Codes

Description Line 1

Expense Account 1 *

Account 1 Amount *

$ Dollars . Cents

Upload Invoice(s) or Receipt(s) *

You can upload multiple attachments.

Optional Additional Expense Accounting

This section is only for checks that may have sub-totals and different corresponding codes. If there are more than two, please explain in the "What is this check for" section.

Description Line 2

Expense Account 2

Account 2 Amount

$ Dollars . Cents

Description Line 3

Expense Account 3

Account 3 Amount

$ Dollars . Cents

After you submit this form, you will receive an email confirmation and it will be emailed to the Synergos finance department for processing.

If you select "save and return later," you will be redirected to a screen with the URL. You have 7 days to return to this form to complete and submit it.