Check Request
Vendor #___________________
Please issue payment to:
Name ______________________________________________________________________
Address ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Payable on __________________________________in the amount of $ _______________________
Charge to account #
Department
Amount
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Requested by: ____________________________________________ Date: _____________________
Approved by: _____________________________________________ Date: _____________________
Mail check to vendor (or)
Return check to: ________________________________________________@ Box #__________
Hold check for pick up in the Accounting Department
Explanation of Payment: