Check #_________

CHECK REQUISITION FORM

Date of Request:________________________________

Requested By:_________________________________

Check Payable To:______________________________

Amount:_____________________________________

Reason/For:__________________________________

                        __________________________________     

Date Paid:    __________________________________

Activity Account:_______________________________

If a receipt or invoice is not attached, the reason must be documented:    

                        __________________________________

                        __________________________________

Approval Signature:_____________________________

Two days is required to process all checks