ATU REQUEST FOR CHECK DATE:_____________________
Honoraria Game Officials Refunds Stipends Agency Funds Other
Supporting documentation MUST be attached to the Request for Check Form
OR
If no documentation is available, this form MUST be signed by the Payee
AGENCY FUND REQUESTS must be submitted to the Accounting Office, Administration Building,
Room 208 for verification. The Accounting Office will forward to the Disbursing Office for processing.
All other check requests are to submitted to the Disbursing Office, Administration Building, Room 206.
Check Requested By: ________________________________________________________
(Department or Office)
Services Performed for: ________________________________________________________
(Name of Department, Office or Agency Account)
FOAPAL #: ____________ ____________ ____________ ___________
Fund Organization Account Program
The vendor block must be
completed before check
request will be processed.
T01
Vendor Number Vendor Address No.
Check Payable To: ________________________________________________________
Description of
Services/Goods OR
Reason for Refund: ________________________________________________________
Amount of Check $______________________
Check Requested By:_____________________________________
Signature
Approved By: _____________________________________
(Signature of Immediate Supervisor)
Signature of Payee: _____________________________________
(If required. See above)
Form ATU-086
Revised 07-24-06
