Check Request
CURRENT DATE:
Name of Vendor/Employee:
Street Address:
City, State, Zip:
For new vendors please attach W-9. For non-residents please attach W-8Ben.
Purpose:
ALLOCATION CHARTFIELD
Account (4) Fund (4) Department (6) Program (4) Class (5) Project/Grant (8) Amount
TOTAL:
Authorized Signature:
Na
me: EXT:
Authorized Signer is certifying that he/she is authorized on the Chartfield combinations, and the charge is
an appropriate expense within college policies.
Please print, attach all supporting documentation and return to Accounts Payable, O'Kane 159.
Date Desired:
Check here if check should be issued separately
from other payments:
FOR ACCOUNTS PAYABLE USE ONLY
Voucher #
Vendor ID #
Handling
ALLOW SEVEN WORKING DAYS FOR PROCESSING
$ 0.00