CheckRequestVendor#___________________
Pleaseissuepaymentto:
Name______________________________________________________________________
Address______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Payableon__________________________________intheamountof$_______________________
Chargetoaccount# Department Amount
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Requestedby:____________________________________________Date:_____________________
Approvedby:_____________________________________________Date:_____________________
Mailchecktovendor(or)
Returncheckto:________________________________________________@Box#__________
Holdcheckforpickupinthe AccountingDepartment
ExplanationofPayment: