The College of William and Mary
Bank of America Visa Payment Form
The Bank of America (BOA) Visa Payment Form is a combination of the coversheet and the purchases log.
Step by step instructions for completing the form are included below.
1. Complete the BOA Visa payment form
2. Attached original statement.
3. Attached original receipts for all purchases made for: Rental Car, lodging, and meal purchases.
4. Meal purchases must include number of participants, per diem rate, average cost per participant,
type of meal consumed, and business purpose.
5. Forward to Accounts Payable for processing before the deadline.
Department Enter the name of the department
Cardholder’s Name Enter the name of the BOA Visa Cardholder
Card Number Enter the BOA Visa card number
Statement Closing Date Enter the closing date for the BOA statement being paid.
Cardholder’s Signature Cardholder must sign here
Banner Account Distribution Enter the Banner Index number and the Banner account number
and the amount that will be charged to the budget for the items or
services on the invoice.
Purchases Log. For each item purchased during this statement period, you must complete the required
fields below. If additional space is needed, use the Bank of America Visa Purchases Log Continuation
Purchase Date Enter the date that the item was purchased
Vendor Enter the name of the vendor/store where the item was purchased
Item Description Enter a brief description of the item purchased
Index Enter the Banner Index Number
Account Enter the Banner Account Number
Amount Enter the amount charged for the item
Approval The Payment Form must include the original signature of person who
has approval authority for the index being charged.
Revised: July 2009