Distribution of check:
Check Request
Give check to:
Total:
Account Code(s): Amount(s):
Total:
Pay to:
VENDOR ID#: (required)
Description of Expenditures (attach supporting documents) Quantity Unit Price Total
Department Name:
Requested by: Date:
Approved by: Date
Please list phone extension of person check is being given to
in the above box.
Print Form
U.S. Mail
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