Campus Labs Billing Information Form Relevant Information for Procurement/Finance

Primary Contact Information

Institution Name:Kentucky State University
Primary Contact:Dr. Michael Dailey
Title:Dir Distance Learning/Inst. Design
Mailing Address:400 East Main Street Frankfort, KY 40601
Phone:502-597-6238Fax:
Email:Michael.Dailey@kysu.edu
Send invoices to my attention:Yes ☐No ☐

Billing Information (if different than above)

Billing Contact: Accounts Payable

Title: Rebeccus Persons

Mailing Address: 400 E. Main Street

City, ST ZIP: Bldg. ASB Room 430

Frankfort, KY 40601

Phone: 502-597-6612 Fax:

Email: accounts.payable@Kysu.edu

Will Campus Labs be issued a PO for this requisition? Yes No ☐

Is a Campus Labs invoice required for PO generation? Yes No ☐

PO number is provided: