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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