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CHECK REQUEST FORM CHECK REQUEST FORM

Please complete the following: Please complete the following:

Date of request Date of request


Name of Requestor Name of Requestor

Make Check Payable to Make Check Payable to


Check Amount Check Amount
Descriptions of Purchase/Items Descriptions of Purchase/Items
Particulars Particulars

Requestor's Signature Requestor's Signature

All receipt(s) MUST be attached to this form if items have already been All receipt(s) MUST be attached to this form if items have already been
purchased. If purchase has been approved but not yet made, please submit purchased. If purchase has been approved but not yet made, please submit
receipts to the Accounting Department as soon as possible. receipts to the Accounting Department as soon as possible.

ACCOUNTING USE ONLY ACCOUNTING USE ONLY


Date Check # Check Amount Date Check # Check Amount

Approved By: Accounting Initials Approved By: Accounting Initials

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