Use this when

A team member or vendor needs payment approval before a bill, reimbursement, or internal payout is processed.

Then

Attach supporting documents, approve or decline, then process payment in your accounting or banking system.

Review before sharing

Check names, dates, totals, and scope. Use a secure system for sensitive details that do not belong in a simple form.

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Live document preview1.0.0

Your business

Payment Request Form

1.0.0

Your completed fields will appear here. Load the example to see a finished document.

Agent-readable document text

PAYMENT REQUEST FORM
Document version 1.0.0


Created with FreeBusinessForms.com

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Template notes

Practical review notes

This template helps create a consistent business record from the information you provide. Review it for accuracy, keep the supporting approval or receipt with the finished file, and use qualified advice when legal, tax, payroll, regulated, or location-specific requirements matter.

Good practice

Use a consistent document number.
Keep the source approval or receipt with the form.
Review names, dates, totals, and scope before sending.

Machine access

Agents can inspect and validate the same versioned fields used here.

View JSON Schema →

Inspect JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://freebusinessforms.com/schemas/payment-request-form.json",
  "title": "Payment Request Form",
  "description": "Route a payment, reimbursement, vendor bill, or internal expense request for review without storing full bank or card details.",
  "type": "object",
  "additionalProperties": false,
  "properties": {
    "business_name": {
      "title": "Business name",
      "type": "string"
    },
    "requester_name": {
      "title": "Requester name",
      "type": "string"
    },
    "requester_email": {
      "title": "Requester email",
      "type": "string",
      "format": "email"
    },
    "payee_name": {
      "title": "Payee or vendor",
      "type": "string"
    },
    "request_date": {
      "title": "Request date",
      "type": "string",
      "format": "date"
    },
    "amount_requested": {
      "title": "Amount requested",
      "type": "number"
    },
    "payment_reason": {
      "title": "Reason for payment",
      "type": "string"
    },
    "related_document": {
      "title": "Invoice, PO, receipt, or job reference",
      "type": "string"
    },
    "preferred_payment_method": {
      "title": "Preferred payment method",
      "type": "string",
      "enum": [
        "ACH",
        "Check",
        "Card",
        "Payroll reimbursement",
        "Other"
      ]
    },
    "approval_status": {
      "title": "Approval status",
      "type": "string",
      "enum": [
        "Pending",
        "Approved",
        "Declined",
        "Needs more information"
      ]
    },
    "approver": {
      "title": "Approver",
      "type": "string"
    },
    "notes": {
      "title": "Notes",
      "type": "string",
      "description": "Do not enter full bank account, routing, card, password, or tax ID details."
    }
  },
  "required": [
    "business_name",
    "requester_name",
    "payee_name",
    "request_date",
    "amount_requested",
    "payment_reason"
  ],
  "x-form-version": "1.0.0"
}