DLC Invoice Submission/Check Request

ONLINE CHECK REQUEST FORM
Check Request Submission Date
Check Request Number
Requester Information

Enter your information in the section below.
Name:*

First NameLast Name
Email:*
example@example.com
Expense Approver:*
Vendor & Purchase Information:

Enter the vendor information below.
Vendor Name:*
Invoice Due Date:

MonthDayYear
Date
Invoice Number:*
Invoice/Expense Description:*
Is the invoice split between multiple departments/accounts/funds?

YesNo
Fund:
Department:*
Expense Account:*
Class:
Grant:
New Special Program/Activity:
Invoice Total

Upload Invoice Copy:*

Browse Files
.pdf, .jpg, .png files accepted as uploads Cancelof
Should be Empty: