Check Request
Payee Information
Payee Name: __________________________________________________________
Address: __________________________________________________________
City, State, Zip: __________________________________________________________
Payee Data Record Form: On File Attached
Net ID/Fed ID # ____________ Employee Student
Vendor
Department Name: _________________________________
Department Contact: _________________________________
Contact Phone #: _________________________________
Check Delivery Instructions:
□Mail to Payee
____________________
□Call for Pickup Phone:
1
2
3
4
TOTAL AMOUNT $:
Purpose/Event Description: Include Location, Date & Time
Prepared by: _______________________________ Date:___________________ Phone: ________
Approved by: _______________________________ Date:___________________ Phone: ________
For Accounting Use:
Vendor # ______________ Voucher #
_________________
For Hospitality Purposes only *
In addition to above required info, please fill in this area:
Total # of On-Campus Participants ______
Total # of Off- Campus Participants ______
Note: When alcohol is served at any campus event, an Alcohol Approval Form must be completed and on file.
*Exception –Reimbursement permitted only if all food and beverage receipts for a single event total less than $100.
All Fields are Required Information
