I am requesting a check for the following: Vendor Name:         ___________________________________________ Vendor Address:     ___________________________________________ ___________________________________________ TIN or SSN:  ___________________________________________ Terms:         ___________________________________________ Due Date:    _____/_____/_____ Amount of Check to be issued:    $____________ PLEASE ATTACH SUPPORTING DOCUMENTATION (IE: INVOICE) Employee Signature: ___________________________________________ Manager Signature: ___________________________________________ Dept/Budget location to be charged: _______________________________ Date:  _____/_____/_____