How to Fill out the Third Party Authorization Form

This How To is to assist with filling out the Third Party Billing Authorization Form.  This form is to be submitted at the beginning of each semester you are expecting to receive a third party payment.

**Please Note:  If your Third Party Billing Sponsor is NOT requesting an invoice directly from the University before payment will be made, then the payment is not considered Third Party.  This form is only for qualifying Third Party Billing Sponsor payments.

1. Go to the Third Party Billing Authorization Form. 

2. Read through the information, scroll down, and click Add to Cart.

3. Scroll down.

4. Fill in the required information.  

a. Please be specific when Choosing your Third Party Sponsor in the drop down.  Please note that some will have you provide further information pertaining to the sponsor.
      i. Example: Military - Which branch?  Air Force, Army, Coast Guard, Marines, Navy, Veteran Affairs - Choose from drop down selection.
     ii. Example: Rehabilitation Services - What city is the Service Location?  Arkansas Rehab-Little Rock or Arkansas Rehab-Jonesboro, etc.

5. Click on Continue when done.

6. It will show you what you entered.  Please verify you entered information correct.  

7. Scroll down and click Checkout

8. You can setup a Login if you choose or Checkout as a Guest.
      a. If you create a Login, then remember it as it is not tied to your Pack Portal nor Self Service account.  You will need to remember for the next time you attempt to check out in our Marketplace system.
      b. If you check out as a Guest, then be sure you enter the correct email address so you receive a copy of the form.

9. Click on Submit Order.

10. Once submitted, a copy will be sent to you and another copy to our Third Party Billing Processors automatically.  

If you have any questions about Third Party Billing, then please contact the Treasurer's Office at 870-972-2285 or thirdparty@astate.edu.