Date Description of Materials/Service Quantity Unit Price Amount Vendor Certification Total I certify that the above bill is just, true and correct; that no part thereof has been paid except as stated and that the balance is actually due and owing, and that taxes from which the State is exempt are excluded. Discount % Vendor's Signature in Ink Title Net Date Name of Company NYS Agency Information Vendor Identification Number Voucher ID Vendor Location ID Vendor Address Sequence B.
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How to fill out the Fillable Ac3253 Form online
Filling out the Fillable Ac3253 Form online can simplify the process of submitting claims for payment. This guide provides a clear step-by-step approach to help users complete the form accurately and efficiently.
Follow the steps to complete the Fillable Ac3253 Form online.
- Click the ‘Get Form’ button to access the Fillable Ac3253 Form and open it in your preferred editor.
- In the 'Vendor Information' section, enter the vendor name, identification number, address, city, state, zip code, invoice number, and the purchase order number along with the date.
- Next, provide a detailed description of the materials or services rendered, including the quantity, unit price, and total amount.
- In the 'Vendor Certification' area, read the certification statement and ensure accuracy regarding the bill, then provide the vendor's signature in ink, title, and date.
- Fill in the 'NYS Agency Information' with details such as the agency's vendor identification number, voucher ID, vendor location ID, and any other relevant information.
- Complete the 'PeopleSoft Format Charge Lines' and 'Legacy Format Charge Lines' sections if applicable, ensuring accurate entries for business unit, department, program, fund, account, project ID, and amounts.
- After all fields are filled, review the entire form for correctness, save your changes, and choose to download, print, or share the form as needed.
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