[PDF]check request form (02/17) - Rackcdn.comc567ce00fd1d6e470c9e-0ffe20c193c9acfcde52974f0c0cbf43.r67.cf2.rackcdn.com/...
0 downloads
45 Views
250KB Size
CHECK REQUEST FORM (02/17)
Make check payable to: ____________________________________________________ Mail check:
_____ OR
Deliver check to: _________________________
Address:
____________________________________________________ ____________________________________________________ ____________________________________________________
Amount of check:
$_____________
Date check needed:
___/___/______
Purpose of check:
________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
Invoices, receipts or other supporting documentation attached:
Yes ___
No ___
If this payment is for an individual’s services, do we have a Form w-9 on file (so we have their address and social security number)? N/A, not for an individual’s services ___ Yes ___ Check requested by:
No ___ (obtain and attach)
Don’t know ___
Name: _____________________________________ Signature: __________________________________
Check request approved by:
___/____/______
Date:
___/____/______
Name: ______________________________ Signature: ___________________________
----------------------- Business Office
Date:
-----------------------------------------------------------------------------------------------------------------
Account number
__.________
Description
_________________________________________________________________
Is this a Form 1099 payee?
Yes ___
Account name _______________________________________
No ___