Hotel Prepayment

DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH

ROY COOPER MANDY COHEN, MD, MPH GOVERNOR SECRETARY

DANIEL STALEY DIRECTOR HOTEL PREPAYMENT

SUBJECT: Request for Hotel prepayment Section Name: Vendor ID: Vendor Name: Invoice Number: Amount: Account: Center:

DATE: March 01, 2017

The Division of Public Health is requesting authorization to process a prepayment to [ Hotel name] for [Purpose - i.e. conference, workshop] for the following individual(s):

Staff name(s): Length of stay (Enter Dates): Cost per night: $0.00 + applicable taxes and fees

Explain: Enter verbiage according to the situation. Enter information about the conference/ workshop attending or staff inability to upfront costs and any supporting documentation List funding source to be used: (100% State or Federal). Enter information in request to pick up the check if applicable. Prepay letter must be accompanied by approved Cash Management Exception (CME) form for any other payment method other than directly to vendor.

Please contact ______at ______if you have any questions or need additional information.

Thank you for your consideration of this request.

______Section Chief/ Designee Date

______Chief Budget Officer Date

______Division Director/ Designee Date

www.ncdhhs.gov Tel 919-707-XXXX • Fax 919-XXX-XXXX Location: XXXX Six Forks Road • Raleigh, NC 27609 Mailing Address: XXXX Mail Service Center • Raleigh, NC 27699-XXXX An Equal Opportunity / Affirmative Action Employer