ATU REQUEST FOR CHECK DATE:_________________
Honoraria
Game Officials
Refunds Stipends Agency Funds Other
Suppor
ting documentation MUST be attached to the Request for Check Form
OR
If no invoice is available, this form MUST be signed by the Payee and a memo submitted as documentation
A
GENCY FUND REQUESTS must be submitted to the Accounting Office in Browning Hall, Rm 312
for verification. The Accounting Office will forward the check request to Accounts Payable.
OTHER CHECK REQUESTS are to be submitted to Accounts Payable in Browning Hall, Rm 302.
Check Requested By: _______________________________________________________
(Department or Office)
FOAPAL #:
______________ ___________ ____________ ____________ ___________
Index
Fund
Organization Account Program
The vendor block must be
compl
eted before check
request will be processed.
_________________________ RA_______
Vendor Number/T Number
Vendor Address No.
Description of
Services/Goods OR
Reason for Refund:
___________
_________________________________
____________
Amount of Check
$______________________
Requested By: _____________________________________
(Signature)
Approved By:
_____________________________________
(Signature of Immediate Supervisor)
Signature of Payee: _____________________________________
(If required. See above)
Form ATU-086
Revised June 2015
Check Payable To:
____________
_
___________
______________________________
__
Send Check To Address
: ____________________________________________
____________
_
____________________________________________
___________
Checks not mailed must be picked up by the payee only.
T
Check Box for Pickup
Email Address for Notifications
_____________________________
