ALL FIELDS MUST BE COMPLETED
DATE:
REQUESTED BY:
DEPARTMENT:
TELEPHONE:
NAME :
ADDRESS 1:
ADDRESS 2:
CITY/STATE/ZIP:
FEDERAL TAX ID:
$ CHECK#
CK AMT
TOTAL: $ USE TAX $
DEPT. CHAIR/ADMINISTRATOR
COLLEGE PRESIDENT DATE PROCESSED BY: ACCOUNTING DATE
ORIGINAL receipts and invoices must accompany each check request. A W-9 Form must be submitted for all
new vendors. For reimbursements of event-related expenses, please indicate the purpose of the event, the date, a
list of attendees, and attach a copy of the invitation/flyer. If the expenditure is funded by a RESTRICTED FUND,
SCHOLARSHIP or PROGRAM GRANT, the Fund Administrator further certifies that the expenditure complies with all
applicable regulations of the sponsoring entity. For UNRESTRICTED FUND expenditures, please attach minutes
reflecting Foundation Board approval. ALLOW 5-7 DAYS FOR PROCESSING.
______________________
HOLD FOR PICK UP
ROUTE TO:
REQUIRED FOR PAYMENT PROCESSING
CHECK DISTRIBUTION
10440 BLACK MOUNTAIN ROAD, SAN DIEGO, CA 92126
CHARGE TO:
MAIL CHECK
PAYEE INFORMATION
TOTAL: $
AMOUNT
SUBTOTAL:
TAX:
$
