STATE OF NEW JERSEY
PAYMENT VOUCHER
(VENDOR INVOICE)		MACSE
DOCUMENT NUMBER		ACTG
PER	FY	
			     		     	    	
							
		PP START	SCHED PAY	CHK	CK	(B) VENDOR        
ID NUMBER         	
		MO	DY	YR	MO	DY	YR	CAT	FL		
	(A) PO #  
     	PV DATE
     	  	  	  	  	  	  	  	  	                                       |
                                            |	
CONTRACT NO	AGENCY REF	BUYER	(C)     TERMS	PAYEE:	SEE INSTRUCTIONS FOR
	COMPLETING ITEMS
	(A) THROUGH (I)	(D)	TOTAL AMOUNT	
     	     	     	     		     	
(E)   PAYEE NAME AND ADDRESS
     	(F)	 SEND COMPLETED FORM TO:

NJDOT
ACCOUNTING OPERATIONS
PO BOX 604
TRENTON NJ 08625-0604	
(G) PAYEE DECLARATIONS
I CERTIFY THAT THE WITHIN PAYMENT VOUCHER IS CORRECT IN ALL ITS PARTICULARS.  THAT THE DESCRIBED GOODS OR SERVICES >> >> >> 
HAVE BEEN FURNISHED OR RENDERED AND THAT NO BONUS HAS BEEN GIVEN OR RECEIVED ON ACCOUNT OF SAID DOCUMENT		
(F)		PAYEE SIGNATURE	
(F)		     		     	
(F)		PAYEE NAME/TITLE		BILLING DATE	
LINE NO	REFERENCE		(H)	PAYEE REFERENCE	
1	CO	AGY	NUMBER	LINE		
	     	     	     	     	     	
2	     	     	     	     	     	
3	     	     	     	     	     	

1	FUND	AGCY	ORG CODE	SUB-ORG	APPR UNIT	ACTIVITY CD	OBJECT CD	SUB-OBJ	REVSRCE	SUB-REV	PROJECT/JOB NO	
	     	     	     	     	     	     	     	     	     	     	     	
2	     	     	     	     	     	     	     	     	     	     	     	
3	     	     	     	     	     	     	     	     	     	     	     	

(I) ITEM      NO.	COMMODITY CODE/DESCRIPTION OF ITEM	QUANTITY	UNIT	UNIT PRICE	AMOUNT	
     	     	     	     	     	     	
     	     	     	     	     	     	
     	     	     	     	     	     	
     	     	     	     	     	     	
     	     	     	     	     	     	
     	     	     	     	     	     	
     	     	     	     	     	     	
	TOTAL	     	

CERTIFICATION BY RECEIVING AGENCY:  I certify that the above articles have been received or services rendered as stated herein.		CERTIFICATION BY APPROVAL OFFICER:  I certify that this Payment Voucher is correct and just and payment is approved.	
			
Signature		Authorized Signature	
     		     		     		     	
Print Name/Title		Date		Print Name/Title		Date	
PV 04/09/2015
PAYMENT VOUCHER (PV) INSTRUCTIONS
BELOW ITEMS MUST BE COMPLETED BY PAYEE

(A) PURCHASE ORDER NUMBER - You must include the correct purchase order number related to this purchase.   A correct purchase order number is a 7-digit number without a dash "-".  An example of a correct purchase order number would be 7342466.  An example of an incorrect purchase order number (aka, Reference number) would be 15-12032. 
•	If you do not have a correct Purchase Order Number, please contact the buyer/receiver of the goods to obtain it.  
•	If you have received a blanket purchase order, a payment voucher still must be completed and submitted with each invoice sent for payment adjusting the Total in (D) and the Total in (I) for the Commodity Code/Description of Item. 

(B) VENDOR IDENTIFICATION NUMBER - Complete the Vendor ID Number field with the federal employer identification (Vendor ID) number. The Vendor ID (a 9-digit number) inserted here must match the information that you provided to the Department Of Treasury when completing the W-9 form to obtain the ID*.   The last 2 digits of this field represents the location code which will determine if the payment is check or electronic payment (ACH), and will be completed by NJDOT Accounting Operations.
 *Vendors must complete the proper paperwork which is the W-9 Form and submit this to Treasury in order to obtain your Vendor ID Number.  Without a Vendor ID Number payment cannot be made.

(C) TERMS - The State of New Jersey Standard Terms and Conditions (6.5) - The New Jersey Prompt Payment Act, N.J.S.A. 52:32-32 et seq., requires state agencies to pay for goods and services within sixty (60) days of the agency's receipt of a properly executed State Payment Voucher or within sixty (60) days of receipt and acceptance of goods and services, whichever is later.

 (D) TOTAL AMOUNT - Enter the total amount of this payment voucher.

(E) PAYEE NAME AND ADDRESS - Complete the Payee Name and Address.  This should be the same address that is your remit to address and should be linked to the Vendor ID Number (A) field above.  Changes to your vendor identification should be accomplished through Department of Treasury, OMB Vendor Control Unit, W-9.

(F) SEND COMPLETED PAYMENT VOUCHER AND INVOICE TO**:
		
		NJDOT ACCOUNTING OPERATIONS
		PO BOX 604
		TRENTON NJ 08625-0604

**Please note that if your invoice contains all required information as governed by Treasury Circular Letter 98-17-OMB, then a payment voucher does not need to be submitted along with the invoice.   Click here for information detailing these requirements.  Only your invoice will be required for billing to the NJDOT.   If you know your invoice does not meet the Treasury requirements please do not submit it without the payment voucher. Doing so will delay your payment since contact with your firm will need to be made to request that the payment voucher be prepared.

(G) PAYEE DECLARATIONS - Payee must sign the declaration, enter the payee’s title, and the billing date.

(H) PAYEE REFERENCE NUMBER - Enter the payee reference number.  This information is recorded on the check stub and aids the payee to identify the invoices which have been paid and will enable matching payables and receivables.  Do not use more than 30 characters.

(I) ITEM NO; COMMODITY CODE/DESCRIPTION OF ITEM, QUANTITY, UNIT, UNIT PRICE and AMOUNT - Must be completed in its entirety.    This area is used to match the information to the internal receiving report submitted by the buyer/receiver of the goods or services.   If the information submitted on the payment voucher by the vendor is not complete or accurate, it will delay your payment.   

INQUIRIES SHOULD BE MADE DIRECTLY TO THE DEPARTMENT OF TREASURY, VENDOR PAYMENT INQUIRY SITE LOCATED AT:  https://www20.state.nj.us/TYM_VPI/home.jsp, if you need access to the Vendor Payment Inquiry site click on the Enroll Here button.

Questions regarding a garnishment can be directed to the Department of Treasury, Division of Taxation at 609-292-6400 or e-mail at AAIUNIT@treas.nj.gov

NJDOT Vendor Help FAQs located at:  http://www.state.nj.us/transportation/business/vendorhelp/faq.shtm
State of New Jersey Standard Terms and Conditions:  http://www.state.nj.us/treasury/purchase/forms/pbst.pdf
Register for the receipt of electronic payments by completing the Electronic Payment Authorization (Vendors) for Automatic Deposits (ACH Credits).  Form and instructions are located at:  http://www.state.nj.us/treasury/forms.shtml#omb