FORM (UT-267)                                              

Policy Reference:              IV.E.1 

Form:                          Departmental Referral Form, UT-267

Obtain Blank Forms From:       Fiscal Administrators.  See page
                               4.6.5.  Make copies as needed.

Forward Completed Forms To:    Original to:  Accounts Receivable
                               Section, Bursar's Office, Carruthers
                               Hall (Retain a departmental
                               reference copy.)


A UT-267 must be prepared for each charge (or group of charges)
referred to the Bursar's Office for collection.  See also Procedure
4-5, "Processing Delinquent Accounts."

Note:  Please print or type the form legibly.


The numbered items on the sample form are to be completed as

 1.  ID NO. (Pos 2-10)    A unique number for this referral   
                          beginning with two alpha characters. 
                          (The two unique alpha characters are
                          initially assigned to each referring
                          entity by the Accounts Receivable   
                          Analyst in the Bursar's Office.)

 2.  NAME (Pos 19-48)     The individual's name entered as:

                          Last name,first name,middle initial. 
                          (Only commas; no spaces between parts of
                          the name.)

 3.  TYPE (Pos 69)        The individual's status relative to the

                                    S = Student
                                    U = University employee
                                    N = Non-University

 4.  SSN (Pos 60-68)           The debtor's Social Security Number,
                               student identification number, or   
                               Federal Employer Identification
                               Number.  (It is important the same
                               number for an individual be used on
                               all his/her referrals so that all
                               debts can be consolidated for
                               collection purposes.)

 5.  CR ACCT (Pos 69-79)       LEAVE BLANK.

 6.  ADDR LINES (Pos 19-78)    The most currently known billing

 7.  ADD'L LINE LOC (Pos 19)   Enter a code only if you need to use
                               an additional address line. 
                               Indicate where you want the
                               additional line placed in reference
                               to the previous three address lines:

                                    F = First line of the address
                                    S = Second line of the address
                                    T = Third line of the address
                                    L = Last line of the address

 8.  ADD'L ADDR LINE           An additional address line when
  (POS 20-49)                  the billing address exceeds three    
                               lines. You must complete position 19 
                               when using this line (see item 7     

 9.  ZIP CODE (Pos 50-54)      Zip code.

10.  TEL NBR (Pos 55-64)       Telephone number, if available.

11.  BAD ADDR FLAG (Pos 71)    If the billing address given is
                               known to be incorrect and the
                               correct address is not available,
                               place a 'B' in this position. 
                               Otherwise, leave blank.

12.  SUBCODE (Pos 11-15)       Enter the BRS charge subcode for
                               this referral.  You may use up to
                               four subcodes per referral.

13.  TRANS NO. (Pos 20-27)     This is for a sequential transaction
                               number.  Use this space only if your
                               office has a system to assign   
                               transaction numbers.

14.  AMOUNT (Pos 56-64)        The amount, by subcode, being
                               referred for collection.

15.  INCUR DATE (Pos 81-86)    The date on which the referred
                               charge was originally incurred. 
                               Enter as month/day/year (mm/dd/yy).

16.  DUE DATE (Pos 87-92)      LEAVE BLANK.

17.  MEMO (Pos 28-55)          A description of the referred
                               charges.  These comments will appear
                               on the bill and should contain
                               information to help the individual
                               identify the specific charge.

ISSUED BY:                                                 04/03/89

University Bursar              4.6.3