ATU REQUEST FOR CHECK DATE:
Honoraria Stipend Game Officials Refund Agency Other
FOAPAL Information:
Fund Org Acct Prog Amount:
Fund Org Acct Prog Amount:
Fund Org Acct Prog Amount:
Check Total
Vendor Information:
The vendor block must be completed before check request can be processed.
Vendor ID (T#) RA
(Vendor Address Number)
Check Payable To:
Vendor Address (Required):
City: State: Zip:
Email Address for Notification:
Amount of Check:
Requested by : Sign & Date
Approval Signature: Immediate Supervisor Sign & Date
Signature of
Payee(If required):
Revised March 2019
Checks must be picked up by the payee. Checks will be mailed if not picked up within a week of the is
sue date.
Description of
Service/Goods or
Select Box for Check Pickup
AGENCY CHECK REQUESTS must be submitted to the Account 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
Supporting documentation MUST be attached to the Request for Check Form
If no invoice is available, this form MUST be signed by the Payee and a memo submitted as documentation
