Subscription Payment Form

Subscription Payment Form
This process enables faculty and staff to work with a centralized team to complete subscription purchases that require card payments, ensuring recurring subscription charges are not placed on P-Cards. The team will respond to requests within 3–5 business days to facilitate the purchase.
Requester Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
USC ID
Purchase Information
Merchant
Frequency of Payment
Please Note: This form and approval is for an entire year if it is a recurring payment.
Weekly Subscription Amount
Note: Please be aware of possible price variances due to tax, dynamic pricing, processing fees, etc.
Total Annual Subscription Amount
Monthly Subscription Amount
Note: Please be aware of possible price variances due to shipping, tax, dynamic pricing, processing fees, etc.
Total Annual Subscription Amount
Quarterly Subscription Amount
Note: Please be aware of possible price variances due to shipping, tax, dynamic pricing, processing fees, etc.
Total Annual Subscription Amount
Annual Subscription Amount
Note: Please be aware of possible price variances due to shipping, tax, dynamic pricing, processing fees, etc.
Term Beginning Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Term End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearTerm End Date should be within one year.
Does the price include sales tax?
Description of purchase and explanation of how item(s) will be used
Please include any justification memos (when required) to help expedite the purchasing process.

Cancelof
Chartfield Information

Enter the Chartfield(s) that should be charged for this purchase. If the purchase will be split across multiple Chartfields, complete an additional row.

Enter below the Chartfield information for the purchase

Rows	Operating Unit	Department	Fund	Account	Class	PC Business Unit	Project	Activity	Cost Share	Amount
Chartfield 1
Chartfield 2

Preferred Purchase Meeting Window

Select your preferred time to meet with the Shared Service team. A Microsoft Teams meeting is required to complete the purchase.
Select a day of the week. Check all that apply.
Select a time window. Check all that apply.
For a specific day/time, please indicate your preference:
Departmental Approvals

Departmental Approval should follow the workflow approver for the department listed above, consistent with Requisitions, Payment Requests, and Expense Reports.
Use the Departmental Approval Query Quick Reference to access the SC_SECURITY_DEPT_APPROVER_ROLE query in PeopleSoft Finance to find departmental approvals by Chartfield.

If using USCSP funds, only the Principal Investigator (PI) signature is required at Level 1.
Level 1 Approver Name

First NameLast Name
Level 1 Approver Email
example@example.com
Level 2 Approver Name

First NameLast Name
Level 2 Approver Email
example@example.com
Is a Dean, Chancellor, or VP approval required for this purchase?
Dean, Chancellor, or VP Name (if required)

First NameLast Name
Dean, Chancellor, or VP Email (if required)
example@example.com
Requester Signature
I acknowledge that I am responsible for providing all required supporting documentation, including receipts, within 48 hours of the transaction or request. Failure to provide the required documentation within this timeframe may result in the suspension of my access to Shared Services after three occurrences.
Requester Signature
Should be Empty:

Subscription Payment Form

Requester Information

Purchase Information

Chartfield Information

Preferred Purchase Meeting Window

Departmental Approvals

Requester Signature