CHECKREQUEST
NotforusewithInvoicesorReimbursements
DonotusethisformforSTUDENTorFACULTYhonoraria(thesemustgotoPayroll)
PLEASEBESURETOALLOW3‐5DAYSFORPROCESSING
TO: AccountsPayable DATE: ______________
FROM: _____________________________________________________
CHECKREQUIREDBYDATE: _______________(allow3‐5daysforprocessing)
Pleaseissueacheck:
PAYABLETO: __________________________________________________________
SOCIALSECURITYor FEDERAL TAX ID #: ___________________________________________________
FORCONTRACTSERVICESANDHONORARIAPLEASEATTACHW9(REQUIRED)
ADDRESS: __________________________________________________________
__________________________________________________________
TOTALAMOUNTOFCHECK: $_____________________________(AttachReceipts)
REASONFORCHECK: ________________________________________________________________________________
________________________________________________________________________________
Distribution:
ItemDescription Amount
Department
3Digits
SubExpenseCode
4Digits
Program
Code
3Digits
FundCode
4Digits
SPECIA
LINSTRUCTIONS: _______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
PLEASECIRCLEONE: ToBeMailed DeliverTo:____________________________________________
AUTHORIZEDSIGNATURE: __________________________________________ DATE: _______________
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