<p> Request to Invoice a Customer</p><p>Please use this form to request an invoice to send to a customer, when the invoice does not fit any of our current billing processes, such as PASS.</p><p>Date: ____/____/____ Name of Requestor: ______Name of Department: ______When payment arrives, what department should the funds be deposited to? I.e. 136-323699-1/9200</p><p>______- ______- __ / ______</p><p>Who should we send the invoice to?</p><p>Company: ______Attn: ______Address: ______City ______State: ____ Zip: ______</p><p>Description of goods or service provided and information to be on invoice: (Example: 7/9/2015 1.5 hour staff time $97.50)</p><p>______</p><p>______</p><p>Please forward this form to: [email protected] General Ledger Office, Second Floor Brigham Hall, Attn: Carissa Menke</p><p>Second Floor Brigham Hall | 608.342.1346 | Fax: 608.342.1236 | [email protected] 1 University Plaza | Platteville WI 53818-3099 | www.uwplatt.edu </p>