Check Request

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:  _____/_____/_____