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Chartfield / Supervisor
Bank Information

Student Information Form for Travel and Expense Reimbursement


(Use this form for Non-Employee FIU Students)

Student Information
Panther ID: Last Name: First Name:

GL Unit: Site: Fund: Program: Budget Ref:

Department ID: Activity Nbr: Project:

Person Authorizing Travel (Supervisor)


Panther ID: Name:

Bank Name:

Bank Account Information (You must provide a copy of a voided check or savings deposit slip with this form)
Account Type: Checking Savings Other
Bank ID (Routing/ Transit Number): Account Number:

Request For Proxy


PID of Proxy Name of Proxy

Approval
Approved by Business Unit Approver
Signature: Panther ID:
Title: Date:

Office of the Controller


11200 S.W. 8th St. Modesto A. Maidique, CSC 410 Miami, FL 33199
Tel: 305.348.2161 http://finance.fiu.edu/controller/index.html
Please send the completed form to vendors@fiu.edu for processing.
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