Non-Employee Incident Report Form

Non-Employee Incident Report Form

*If you are having difficulty completing this online form, please contact Risk Management at riskmgmt@bussvc.wisc.edu.

Occupational Therapy Deposit Forfeiture Form

Use this form to submit an enrollment forfeiture for the Occupational Therapy program to the Bursar’s Office for posting to a student’s account in the Student Information System (SIS). 

Use this form to submit an enrollment forfeiture to the Bursar’s Office for posting to a student’s account in the Student Information System (SIS).


This form is specific to the Occupational Therapy program.

Download the Occupational Therapy Deposit Forfeiture Form (Excel)

Instructions

  1. Enter Term Code.
  2. Complete Campus ID, Name, and Amount.
  3. Save the form to a folder on your computer. You may assign any file name desired.
  4. Upload the form to the Bursar’s Office Secure Website.

Outgoing Wire Forms

Use this form to complete an Outgoing Wire or Draft payment.

Use these forms to pay a vendor or other service provider via wire transfer check.


Download the Outgoing Wire Form (PDF)

Outgoing wire form instructions

The completed Outgoing Wire Form should be attached to your Expense Request and sent to Accounts Payable for review and approval. Wire transfers should primarily be used to pay an international vendor or other service provider. A wire transfer should only be used to pay a domestic (within the USA) vendor or service provider because an ACH is not timely; this should be a one-time solution.

If the banking information of the beneficiary is not listed on the invoice, please include the original source of the banking information entered on this form as supporting documentation (i.e. copy of email from the beneficiary).

Contact acctg@bussvc.wisc.edu with any questions regarding the form or the status of your wire transfer.

Wire transfer information

Payment amount: List the amount due and the currency as agreed upon per the vendor’s invoice or other agreement. Any conversion of funds to a different currency will be completed by Cash Management at the time the wire transfer is completed.
Routing number/ABA: A 9-digit number used to identify a domestic (within the USA) financial institution. Not required for foreign banks.
Bank name: Name of the financial institution where the funds will be deposited.
Bank address, city, state, zip Code, country: Physical location of the bank of the beneficiary’s bank.
Beneficiary/Name on bank account: Exact name on the beneficiary’s bank account as identified by the bank.
Beneficiary account number: The bank account number of the beneficiary or account holder.
Beneficiary address, city, state, zip Code, country: Physical location of the vendor or the beneficiary’s residence.
Reference for beneficiary: Invoice information for the vendor to be able to identify the payment (25-character limit).
Beneficiary email for payment verification: Email address where payment verification will be sent.

Additional information required for international wires

Payment currency: Select the currency the wire transfer should be completed in.
**List of currency types available to process wire transfer payments

SWIFT code: An international bank code that is 8 or 11 characters and identifies a particular bank worldwide. It is also known as a Bank Identification Code (BIC).

IBAN: An International Bank Account Number (IBAN) is a standard international numbering system used for bank accounts. Commonly used for accounts held at banks in countries in the European Union.

Payments to Mexico

  • CLABE Number: An 18-digit number that is a banking standard used by bank accounts held at banks in Mexico.

Payments to Canada

  • Account Number: A 7-digit number. May be 12-digits if combined with transit number.
  • Transit Number: A 5-digit number.
  • Bank/Institution Number: A 3-digit number.

Intermediary bank information

This information is not required for all wire transfers. The beneficiary will provide this information if it is needed to complete the wire transfer.

Intermediary US Bank Name: Third-party bank within the US used to facilitate the international transfer of US Dollars to a foreign bank. Not required.
Intermediary US SWIFT Code: An international bank code that is 8 or 11 characters and identifies a particular bank worldwide. It is also known as a Bank Identification Code (BIC). Not required.

Funding string for bank fee

Funding for bank fees will be charged to the original funding on payment.

Type of wire transfer Amount of fee
International Transfer in Foreign Currency $0.00 (No Fee)
International Transfer in US Dollars $16.00
Domestic Transfer in US Dollars $2.25

Approval and acknowledgement

Preparer name: Name of UW–Madison employee who prepared the form.

Payment Notice Form

This form is used when the department knows the vendor will not invoice Accounts Payable for payment.

This form is used when the department knows the supplier/vendor will not invoice Accounts Payable for payment.


This field is for validation purposes and should be left unchanged.
This form is used if an additional or installment of a Purchase Order payment needs to be processed to pay for a good or service. Use this form if you know the supplier will not invoice Accounts Payable.

Please submit this form at minimum two (2) weeks before payment is due.

If more than one (1) payment required, please complete a separate form for each payment. Please note if any special handling is required.

This form is only to be used for Purchase Order payments. Send questions to acctg@bussvc.wisc.edu.

Payment notice details

Address where payment should be sent(Required)
Date payment must be made by(Required)
Special handling requirements, other important information, etc.
E.g., back-up documentation, wire form if paying foreign entity. Please provide all documents in a PDF format.
Drop files here or
Accepted file types: pdf, Max. file size: 10 MB.

    Pharmacy Enrollment Deposit Form

    Use this form to submit an enrollment deposit or forfeiture to the Bursar's Office for posting to a student's account in the Student Information System (SIS).

    This form is specific to Pharmacy.

    Use this form to submit an enrollment deposit or forfeiture to the Bursar’s Office for posting to a student’s account in the Student Information System (SIS).


    This form is specific to the School of Pharmacy.

    Download the Pharmacy Deposit Form (Excel)

    Instructions

    1. On the form, select the transaction type: Deposit or Forfeiture of Deposit. A separate form for each type of transaction is required.
    2. Enter Term Code.
    3. Complete Campus ID, Name, and Amount.
    4. Save the form to a folder on your computer. You may assign any file name desired.
    5. Upload the form to the Bursar’s Office Secure Website.

    Physical Therapy Enrollment Deposit Form

    Use this form to submit an enrollment deposit or forfeiture to the Bursar's Office for posting to a student's account in the Student Information System (SIS).

    This form is specific to Physical Therapy.

    Use this form to submit an enrollment deposit or forfeiture to the Bursar’s Office for posting to a student’s account in the Student Information System (SIS).


    This form is specific to the Doctor of Physical Therapy program.

    Download the Physical Therapy Enrollment Deposit Form (Excel)

    Instructions

    1. On the form, select the transaction type: Deposit or Forfeiture of Deposit. A separate form for each type of transaction is required.
    2. Enter Term Code.
    3. Complete Campus ID, Name, and Amount.
    4. Save the form to a folder on your computer. You may assign any file name desired.
    5. Upload the form to the Bursar’s Office Secure Website.

    Plastic Bank Bag Order Form

    For those departments/divisions using bank deposit slips, use this form to order plastic bank bags. Please allow three weeks for delivery.

    For departments/divisions using bank deposit slips, use this form to order plastic bank bags. Please allow three weeks for delivery.


    The Plastic Bank Bag Order Form is used by departments/divisions who have already set up their own bank deposit slips through Cash Management. If you currently do not have your own deposit ticket and you collect large sums of money and/or frequently collect money, contact your Dean’s/Divisional office for approval and forward this approval to Cash Management at cashmgt@bussvc.wisc.edu.

    Remember: Reorder before current stock is out. Allow three weeks for delivery.

    This field is for validation purposes and should be left unchanged.

    Department Information

    Campus address(Required)
    Be sure to order enough for 6 months.

    Contact Information

    Comments

    Using plastic bank bags

    Wisconsin state statutes dictate all revenue generated as a result of the sale of University goods or services belongs to the University. This revenue must be deposited into the University Deposit Account and recorded on the University’s accounting system. The statutes require deposits be made at least once a week.

    This revenue may not be deposited with the University of Wisconsin Foundation or to an individual’s private bank account. It may not be deposited directly into the University’s replenishable bank accounts, including petty cash accounts and Custodian Funds. Revenue collected is not to be used to make purchases of supplies, equipment, or services.

    Instructions for submitting deposits with plastic bank bags

    1. Complete the Plastic Bank Bag Order Form (above) to request bank bags.
    2. Print the following information on the plastic bank bags (or attach a label):
      • Department six-digit ID number
      • Full department name
      • Contact name
      • Phone number
    3. Do not write the following on the plastic bank bag: 1) deposit amount or 2) bank account number.
    4. After completing the deposit ticket, write the bag number on the deposit ticket copy kept for your records.
    5. Include the following in the plastic bank bag:
      • Original (white) deposit ticket
      • Cash and checks totaling to the amount of the deposit ticket
    6. Seal the plastic bank bag by removing the adhesive tape on the top side/envelop flap of the plastic bank bag. A sealed bag can only be reopened by tearing or cutting it. Please make sure all plastic bank bags remained sealed when delivering them to armored car pick-up sites.
    7. Tear off the plastic bank bag stub that has the pre-printed bag number. Keep this for your records along with the following:
      • All carbon copies of the original (white) deposit ticket that was sent to the bank; these carbon copies will be yellow or pink in color
      • Date of the deposit
      • Amount of the deposit
      • Last four digits of the bank account number (if known)
    8. When dropping off your sealed plastic bank bag at your armored car pick up location, write the bag number on the armored car service log sheet along with any other information the log is requesting. Each drop off site may have their own procedures in place for filling out the log.

    Please email questions to Cash Management (cashmgt@bussvc.wisc.edu).

    Related Documents

    Related Policy/Procedure(s)