DO NOT USE THIS FORM IF VENDOR CAN PROVIDE INVOICE

Checks are issued on Wednesdays if you have an emergency please allow 24 hours

*ALL FIELDS MUST BE COMPLETED

Detailed description of what check is for:

Amount

Account

Class

Vendor Name

**If this is a new vendor please include W-9

check request will not be processed without one**

Should check be mailed?

Please provide address

What should be done with the check?

By checking this box you acknowledge that you are affixing your electronic signature by typing your name in the box below.*

*Staff Electronic Signature

Today's Date