CHECK REQUEST

Ministry

Date

REQUESTER FILL IN THIS SECTION

Date Needed

Aount Requested

Person requesting (please print):

Requester's phone number:

Email *

Make check payable to:

DATE

Address

Street Address

Purpose

Signature of requestor:

Mail payment

Note: Requests are required to be submiteed two (2) weeks prior to payment due date.

Please attach supporting documentation, i.e. estimates, quotes, receipts, W-9, etc.

FOR FINANCE OFFICE USE ONLY

Date Issued

Check #

Charged to what budget item:

Comments

Signature