Liberty Payment Request Form
Company Name
Liberty Enterprises
Form Reference Number
LPRF-2024-001
Date of Request
December 20, 2024
Requestor Information
Name of Requestor: Michael Johnson
Employee ID: LIB12345
Department: Accounts Payable
Contact Details:
- Phone: +1-345-678-9101
- Email: michael.johnson@liberty.com
Payee Information
Name of Payee: Sarah Thompson
Contact Details:
- Phone: +1-567-890-1234
- Email: sarah.thompson@vendor.com
Bank Details (for Transfer): - Account Name: Sarah Thompson
- Bank Name: Liberty Bank
- Account Number: 789456123
- IFSC/Swift Code: LIBB012345
Payment Details
Amount Requested: $2,500
Currency: USD
Purpose of Payment: Vendor payment for December 2024 contract services.
Payment Due Date: December 22, 2024
Supporting Information
Attached Documents: Invoice #INV-2024-567, Service Agreement
Authorization Section
Requested By:
- Name: Michael Johnson
- Signature: _______________________
- Date: December 20, 2024
Approved By:
- Name: Elizabeth Carter
- Signature: _______________________
- Date: December 21, 2024
Remarks/Comments
Payment required to ensure timely vendor services continuation.
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