REQUEST FOR CHECK
UNIVERSITY
ID NO.–VENDOR NAME–PERMANENT ADDRESS–ZIP CODE:
DATE OF REQUEST:
/
/
DATE NEEDED:
/
/
REQUISITIONING DEPT.:
DEPT. CONTACT:
NAME
Banner ID No. or Soc. Sec. No.*
*Required for checks to individuals
PHONE & MAIL LOCATION
ROUTING OF CHECK:
FOR COMPTROLLER’S OFFICE USE
MAIL TO VENDOR
HOLD FOR PICK-UP BY:
ELECTRONIC TRANSFER
PHONE NUMBER:
FUNDS AVAILABLE
YES DATE ________
BUDGET
ET NUMBER(S)
NO
Enter Fund or Org. — NOT BOTH
FUND
ORG.
ACCOUNT
AMOUNT
BY __________
VENDOR
INV. NO.
INV. DATE
BANNER
INVOICE NO.
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ $ ___________._____
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ $ ___________._____
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ $ ___________._____
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ $ ___________._____
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ $ ___________._____
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ $ ___________._____
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ $ ___________._____
0.00
TOTAL $ ___________._____
PURPOSE FOR WHICH FUNDS ARE REQUESTED:
AMOUNT
TOTAL
SIGNATURE (CASH PICK-UP) X
0.00
CERTIFICATION AND APPROVAL
I CERTIFY THAT THE ABOVE REQUEST REPRESENTS A PROPER UNIVERSITY EXPENDITURE, THAT FUNDS ARE AVAILABLE, AND THAT IT IS NOT A
DUPLICATION OF A PRIOR REQUEST.
REQUESTED
BY
APPROVED
ORIGINATOR
Return to Accounts Payable, ML 4531
APPROVED
DEPARTMENT HEAD
CO 0404/2-51122/PDF
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