Check Request Form
Please fill out this form and click submit.
Name of Requester
*
Email
*
This address will receive a confirmation email
Phone
*
Make Check Payable to
*
Give or Mail Check to
*
Address if mailing
Fund Information
Amount of check *
*
Description
*
*All disbursem
ents or reimbursements exceeding $25.00 must be authorized by the committee chair or staff person with disbursement authority in the account description.
The bookkeeper will forward a copy of this request to the approver via email. Please ask them to watch for it and return with their approval as soon as possible.
Account/Budget line the
*
Chair Person who will approve the request
*
Upload a copy of reciept if a reimbursement
Upload (8MB)
Additional Information
For Office Use
Account #
Check number
Check date
Submit
Description
Please fill out this form and click submit.
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