- Name and Address - Enter the payee's full name and address.
- Reason for Request - Enter a reason for the refund request.
- Table (a header row, six columns, and five rows for data entry)
- Column 1 - Dept. Reference Number - Enter the Department Reference Number.
- Column 2 - Department Number - Enter the Department Number.
- Column 3 - Fund # - Enter the Fund Number.
- Column 4 - Object Code - Enter the Object Code.
- Column 5 - Project Number - Enter the Project Number.
- Column 6 - Amount - Enter the Amount. The total is automatically calculated.