University of Virginia -- Procurement Services

Submit this form to request any Invoice Correction, modification, or to notify Accounts Payable that an invoice you have received does not belong to your department.

Indicate type of corrective action and provide ALL needed information:

Apply invoice to new approved PO Number
	Provide complete & accurate information for the PO Line(s) change. Example:    Line 1 - Qty:2 @ $10    Line 3 - Qty:5 @ $50    etc. PO Line Numbers, QTY, and Amounts:
	Freight Amount as indicated on invoice: (enter 0 if none)
Cancel Invoice. You have contacted the vendor, and the vendor will offset the invoice. Put on Department Hold Put on Credit Hold -- Amount: (Department is responsible for contacting the vendor for credit memo(s) to be submitted to A/P) Reason:
Invoice does not belong to this department
Other:

Submitted by:

Your name	*	Purchasing Unit Code (PUC)	*
E-mail address	*	Phone number (x-xxxx or xxx-xxxx)	*