INSTRUCTIONS Transaction Number For use by Finance Chair Transaction #: Please staple here Date Enter the current date MM-DD-YY. To be filled by Finance Chair Honorarium Check Request Form Name Enter payee name. To be completed by Student Organization: Address Enter payee address. Social Security Number Enter payee social security number. Check payable to: Type of Service rendered Describe the type of service rendered (speaker, proctor, tour Name host, guest musician, etc.) E-mail @students.calvin.edu / Account Number For use by the Finance Chair. Address Social Security Number Type of Service rendered 12-digit account number Payment for X-X-XXXXX-XXXXX Total Amount Amount Enter the amount to be paid for the honorarium. Honoraria Purpose: Total Enter the total amount to be paid. The check will be Place: written for this amount. People: Check Sent to Payee? Indicate whether the check is to be sent to the payee Check to be sent to payee? ___Yes ___ No named above. if "no" to be sent to __________________________________________________________________________________ Signatures: (Please Print and Sign) Phone Date Org.'s Financial Officer Name The signature name of the organizations financial officer Organization's Budget Officer Signature Org.'s Advisor Signature The signature of the organization's advisor Finance Chair The signature of the Finance Chair is required here. Organization's Advisor Signature Assoc. Dean/Vice President The signature of the Associate Dean/Vice President is required Finance Chair Associate Dean/Vice-President Return Completed form to Student Organizations' Finance Chair For Accounts Payable Use: Approval for payment: Initials Date Student Development Office CA101B or basket at the front desk of Campus Life East A/P: _________ ________ Date received A/P Controller: _________ ________ Voucher number