Nursing Home Vendor Payment Authorization Form
Nursing Home Vendor Payment Authorization Form
This form is used to authorize payments to vendors providing goods or services to [Your Company Name]. Please ensure all information provided is accurate to facilitate timely and accurate processing of payments.
|
Authorization Information |
|
|---|---|
|
Date: |
|
|
Vendor Name: |
|
|
Vendor Address: |
|
|
Vendor Contact Person: |
|
|
Vendor Phone Number: |
|
|
Vendor Email Address: |
|
Payment Details |
|
|---|---|
|
Invoice Number: |
|
|
Invoice Date: |
|
|
Invoice Amount: |
|
|
Description of Goods/Services: |
Authorization Details:
I, [Your Name], hereby authorize payment to the above-named vendor in the amount specified above for the goods/services provided as described in the invoice.
Authorized Signature:
Date:
