Void Check
Request
Form
Void Only
Void and Reissue
Date: Banner Invoice #:
Requested
by:
Payee
:
Check #:
Check
Date:
Check
Amt:
Reason for Void:
Never received the check
Lost
Incorrect Amount
Incorrect Vendor
Other: ________________________________________________________________________________
For Accounts Payable Use Only
:
Bank: _______ Unclaimed
Property:
Yes
No,
If
Yes,
Year: ________
Check Cleared:
Yes
No Clear Date_______
Voided in Banner:
Yes
No Voided in lntellecheck:
Yes
No
Replaced:
Yes
No
Void positive pay file transmitted to the bank.
Complete by: ___________ Date: __________