Please allow 5 Business Days for Accounts Payable to Process this Request
Mail Check Directly to Address Above OR
Interoffice Check To: Name: Maildrop & Extension:
Pick Up Check: Name: Extension:
Direct Deposit
Requested By: Approved By:
Check Request
Address of Payee/Vendor:
Name of Payee/Vendor:
SSN (If Applicable):
Check Delivery Method:
Cost Center & Expense Acct:
Description of Request:
Please Note: This form should NOT be used to reimburse expenses, request cash advances, or
supplement invoices.
Date Check is Needed:
Total Amount of Payment: