DAC TEST VOUCHER

***TRAINING/TESTING ONLY***

PAYMENT VOUCHER FORM

Detroit Alumnae Chapter | Delta Sigma Theta Sorority, Inc.
Date

MonthDayYear
Date
- Make Check Payable To:
- Mailing address (if to be mailed):
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Amount:
- Check if Restricted:
- Reimbursement or W9:
- Purpose:
  
  Other (Specify)
- Upload Receipts or Invoices
  
  Cancelof
- Take Photo of Receipts or Invoices
- Reporting Code:
  This could also be a dropdown
- Name of Committee or Budgeted item:
  This could also be a dropdown
- Comments or Special Instructions:
- Requester Name
- Requester Signature
- Requester Email Address:
  For electronic routing. This can be hard-coded and hidden. This can also be a drop-down or populated from committee / budget line selection.
- Date Submitted:
  
  MonthDayYear
  Date
- Assistant Treasurer Email Address:
  For electronic routing. This can be hard-coded and hidden.
- Disbursement Type
- Assistant Treasurer's Name:
- Assistant Treasurer Signature
- Assistant Treasurer's Signature Date
  
  MonthDayYear
- President Email Address:
  For electronic routing. This can be hard-coded and hidden.
- President's Name
- President's Signature
- President's Signature Date
  
  MonthDayYear
- Treasurer Email Address:
  For electronic routing. This can be hard-coded and hidden.
- This section is filled out by the Treasurer at or just after the checks are signed by the Treasurer and the President.
- Date
  
  MonthDayYear
  Check Date
- Check Number
- Opening Balance
- Amount this Check
- Closing Balance
- This section is filled out by the Assistant Treasurer or Treasurer when the check is distributed to the payee.
- Date Received by Assistant Treasurer
  
  MonthDayYear
  Date
- Delivered To:
- Date:
  
  MonthDayYear
  Date
Should be Empty: