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Request for Travel Advance
Please Note: The Business Office requires one full week to issue check.
TA #:
see
instructions
BUSINESS UNIT:
choose one
BKCMP
BKASI
BKGAP
BKFDN
BKSTU
Vendor#:
PAYABLE TO:
DATE:
ADDRESS:
AMOUNT:
DATE(S) OF TRAVEL:
DESTINATION:
DEPARTMENT:
EXTENSION:
EXTENSION:
APPROVED BY:
Signature: ____________________________________________________
DELIVER CHECK TO:
" I hereby certify that the above travel advance is necessary to defray my anticipated reimbursable expenses while traveling on business for the State of California away from my designated headquarters. I understand and agree that this amount may be deducted in full from any and all funds payable by the State to me, including any salary warrant(s) issued to me by the State Controller, following receipt of the amount requested."
Account:
Fund:
Department:
Program:
Project:
Class:
CLAIMANT:
CSUB ID#:
Claimant Signature:
__________________________________
DATE SIGNED:
For Business Office Use Only
Paid
by Check No. _________________
Approved By: ___________________
Date: _______________________
107001 ADADV D92110 [ ]
NOTE: Make sure values on form are correct as
VALUES ARE CLEARED BEFORE PRINTING AND FORM IS REFRESHED!