Check Request Form

Requested by: _______________________________Date________

Signature

Amount: ________________

Payable to: __________________________

__________________________

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Reason for Check: _______________________________________

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Budget Category _________________________________________

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Authorized by (President’s Signature)

Check # ________________

Date: _____________________

This expense voucher must be submitted to the Treasurer within 30

days of the expense and must have receipts, invoices or order forms

attached.