Date:

    Submitted By:

    Ministry or Special Emphasis Name:

    Check Request Type:
    AdvanceVendor InvoiceReimbursement

    Is this a Budgeted Item:

    Purpose of Expenditure:

    (All receipts, proposed contractual agreements and anticipated expense statements to support this request must be attached to this form.)

    CHECK INFORMATION:

    Name of Payee:

    Address (if applicable):

    Amount of Check: $

    Payment Due Date:

    ****Reimbursement Checks are available fifteen business (15) days from receipt by finance office. Please plan accordingly. All other Check request processing is a minimum 30 days.*****

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