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Research Institute

RINST Cash Equivalent Subject Payment Entries


Email Address of person entering this entry

* Required
tjohnson@kumc.edu
SpeedType of where Gift Cards were first purchase from

* Required
8 characters
Purchase Order Number * Required
Date the incentive was handed out * Required
Format 11/12/2009
First Name of Person Receiving Cash Equivalent

* Required
Last Name of of Person Receiving Cash Equivalent

* Required
Street Address 1

* Required
Street Address 2

City

* Required
State

* Required
Zip

* Required
Social Security Number

* Required
Cash Equivalent Amount

0.00 - 999.99* Required
Store/Location Cash Equivalent can be used and /or Money Order/Gift Card#

* Required
 
 
This page last updated: September 11, 2007