Check Request Form

Check Request Form
This form is to be completed for purchases, reimbursements or budget requests and returned to the church office at least 14 days prior to the date that the check is needed. Please attach any sales slips, receipts or invoices.
Date

MonthDayYear
Date
Due Date

MonthDayYear
Date
Check One

[ ] Purchase[ ] Reimbursement[ ] Budget Request
Check Request Explanation
Amount
Type a question

Mail CheckPick-Up CheckDebit/CreditEFT/ACH
Make Check Payable to:
Name
Address

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Requested by
DO NOT WRITE BELOW THIS LINE (FOR OFFICE USE ONLY)
Account Charged
Check No.
Date

MonthDayYear
Date
APPROVAL SIGNATURES:
Treasurer
Date

MonthDayYear
Date
Other Officer
Date

MonthDayYear
Date
Should be Empty:

Make Check Payable to: