Billing Intake Form

CLATR Billing Intake

Instructions

Please fill in form completely.

We can only accept payments via personal check or money order, UW Worktag, or purchase order. If you have any questions about these payment methods, please email Center for Laboratory Animal Training Resources at clatr@uw.edu.

CLATR invoices are sent via email to the requestor and any emails listed under “Send Invoice to” are sent after personnel have attended their registered class.

Billing Information

Paying with a UW Worktag: Please provide Cost Center, Balancing Unit, Function, and Fund worktags.

Paying with Personal Check: If you are UW personnel paying for a re-registration fee using a personal check or money order, the cost of the re-registration fee will be the same as non-UW personnel.

From an Outside Institution: Please include a Purchase Order (PO) number below in the Payment Method field.

Requestor Information

Requester’s Name

Email Address

Phone

Invoice Recipient Name

if different than requester.

Send Invoice to (email)

if different from requestor email.

Bill To

Who we are sending the bill to

Company Name

Address

ATTN

Payment Method

Method Options

Personal check

Money Order

Purchase Order (PO) # (if applicable): Purchase Order (PO) # (if applicable):

UW Cost Center/Worktag #

Enter all your Dept Worktag Numbers

Service Requested

Attendee Name

Class Name

Cost/Class

Attendee Name

Class Name

Cost/Class

Attendee Name

Class Name

Cost/Class

Attendee Name

Class Name

Cost/Class

Attendee Name

Class Name

Cost/Class

Total

Notes

Upon receiving an invoice, please mail check to:

University of Washington
Office of Animal Welfare
Box 357160
Seattle, WA 98195-7160

If you are human, leave this field blank.

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