2. DEPARTMENT:*
4. ENTRY CLERK:*

   Person(s) authorized to enter invoices

6. ENTRY BACK-UP:

   Secondary person(s) authorized to enter invoices

8. DEPARTMENT APPROVAL:*

   Person(s) authorized to APPROVE invoices

10. ADMIN APPROVAL:

    (if applicable)

12. NOTICE:

    This replaces all previous authorizations submitted. Please verify the information is correct, sign, date, and submit.

14. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree
16. Electronic Signature
18. Date
    Date
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

* indicates a required field