Vendor # _____________
CHECK REQUEST FORM
BUSINESS OFFICE USE ONLY
Voucher # _____________
BUSINESS OFFICE USE ONLY
Pay to the Order of _________________________________________________
PLEASE PRINT OR TYPE
Today’s Date __________________________________________
Date check needed______________________________________
Amount $ _____________________________________________
Invoice # _______________________ Invoice date____________
Account number to be charged ____________________________
Special Instructions:
Requested by __________________________________________
Approved by department head _____________________________
Print department head’s name _____________________________
Reason for expenditure:
ATTACH ALL RECEIPTS
☐ Mail to: (please give address)
☐ Return to
☐ Enclosure
☐ List: (i.e. students needing application fees)
More special instructions, if needed: