CHECK REQUEST FORM - DOC

							                          CHECK REQUEST FORM


Normally checks are cut within two to three weeks of receipt of invoice. If
your check is required within 1-2 weeks without an invoice, please use
this form.


Amount of check: ____________________________

Form submittal date: __________________________

Requested date of check: ______________________

       Check Payable to: ______________________________________
              Vendor Address: __________________________________
       City ____________________ State ________ Zip Code ________


Description of work done or material provided by vendor:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________


Person initiating request: _____________________________________

_______________________________             _______________________
  Executive Director’s Signature            Date

Please attach copy of vendor’s invoice and code below

    FUND CODE    FUND SOURCE      GL CODE       ACTIVITY


     JOB CODE     PROJECT MGR     EXE DIR        AMOUNT




Check Request Form
12/12/2002