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AVCSD Reimbursement or Check Request
Name of person requesting check:
*
First Name
Last Name
Should the check be wrtitten to the person making the request?
Yes
No
Address:
Mailing Address
Mailing Address Line 2
City
State / Province
Postal / Zip Code
Requester's Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Requester's Email:
*
example@example.com
Make Check To:
Send Check To:
Name
Mailing Address
City
State / Province
Postal / Zip Code
Branch
*
Please Select
Recreation Department
Teen Center
Skate Park
Airport
CSD
Water Project
Total Amount of Check
Is this a check request or a reimbursement?
*
Check request - hasn't yet been paid
Reimbursement request - I've already paid
Details
*
Comments
Include funding source if you know it.
Is this request time-sensitive? (If so, call or email the AVCSD office to alert us.)
Yes
No
If yes, we'll try to expedite, but it could still take a week. When do you need the check?
-
Month
-
Day
Year
Date
Upload receipts or invoices here. Requests submitted without documentation will be delayed.
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