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Payment Request Form Template

Streamline Your Collection Process with This Template

Chasing overdue payments can be a frustrating process. This payment request form template is designed for businesses, freelancers, and individuals needing a clear, professional way to request payments. With this template, you can easily create a formal request that outlines payment details, ensures clear communication, and tracks payment history, improving your cash flow and reducing follow-up efforts. Plus, it features WCAG-aligned labels for accessibility. Start using the live template to make payment requests more efficient.

Your full name
Your email
Cost center or project code
Payee type
Individual
Business
Nonprofit
Government
Prefer not to say
Other
Please Specify:
Payee legal name
Payee email for remittance
Check mailing address (if check is selected)
Preferred payment method
Bank transfer (ACH/SEPA)
Wire transfer (SWIFT)
Credit/debit card
PayPal
Check
Cash
Other
Please Specify:
Payment category
Goods
Services
Subscription
Travel
Reimbursement
Refund
Grant/Donation
Royalty/License
Other
Please Specify:
Payment description
Amount (numbers only)
Invoice or PO number (if applicable)
Due date
Currency
USD
EUR
GBP
CAD
AUD
JPY
INR
Other
Please Specify:
Bank name (if bank transfer or wire)
Account number or IBAN (if applicable)
Routing number or Sort code (if applicable)
PayPal email (if PayPal is selected)
Link to invoice or receipt (URL)
Additional notes for finance
I certify that the information provided is accurate and the payment complies with company policy
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Type your full name as signature
Signature date
Approval decision (if applicable)
Yes
No
{"name":"Your full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Your full name, Your email, Cost center or project code","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
paper art illustration depicting a payment request form with various fields and a pencil for filling out information

When to use this form

Use this form when you need to trigger a one-time payment to a vendor, contractor, employee, or partner. It works for invoice settlements, milestone payouts, refunds, reimbursements, or grants. You capture payee details, amount, due date, method, and approvals so finance can move funds fast and keep an audit trail. If the disbursement must be issued as a company check, use the Accounts payable check request form. For internal one-off checks not tied to an external vendor, start with the Check request form. Handling sales commissions? Route those through the Commission disbursement authorization form. The result is fewer back-and-forths and on-time payments.

Must Ask Payment Request Questions

  1. What is the total amount requested and the currency?

    This confirms the exact liability and routes the request to the right approval level. It also reduces rework from rounding errors or currency mismatches.

  2. What is the business purpose and the related invoice, PO, or contract number?

    Stating the purpose and a reference number links the payment to work delivered. If the expense came from a corporate card, attach the Credit card receipt form to support the charge.

  3. Who is the payee, and what is the preferred payment method?

    Payee details and method (ACH, check, or card refund) prevent delays and returned funds. Clear instructions help finance pay the right party the first time.

  4. When is the payment due, and are there early-pay discounts or late-fee terms?

    Due dates and terms help finance prioritize the queue. Clear timing avoids penalties and can capture early-payment savings.

  5. Which cost center or project should we charge, and who is the approving manager?

    Allocating the cost and naming the approver ensures accurate accounting and policy compliance. It also speeds signoff because the right person sees the request first.

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