Check Request Form
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1CHECK REQUEST
Date________________
PAYEE
ADDRESS
Is the payee or beneficiary of this payment a U.S. Citizen or Permanent Resident Alien?
Yes
No
Don’t Know
(If Yes, there is no change to current procedures; if No or Don’t Know, provide the payee with a Tax
Compliance Notification Sheet (TCNS) and a W-9*. When the completed form(s) are returned to you, attach
the form to the check request and supporting documents. Forward the entire packet to Accounts Payable.)
Yes
No
Gross Up:
Is this compensation for services? Yes
No
(If yes, and payee is an employee, please process through payroll.)
Yes
No
Is this for reimbursement for expenses for an employee?
(If yes, please use Employee Expense Reimbursement Form)
Fund
Organization
Account
Activity
Amount
Description
Approval by
Date wanted:_____________________________
Total : $____________
Dept. Head:____________________
Return to Department (Name)_____________________
Send in U.S. mail
Hold for Pick-up @ A/P
*See Business Office website for forms
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Parent category: Business