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Check Request Form

Instructions:

Only 1 vendor per request
Multiple invoices from the same vendor can be combined on one check request
Check request form can be used for purchases in amounts up to $2,499.99, unless it’s an exempt item (Registrations, memberships, certifications, shipping)
Ensure that sales tax is not included on invoices

Date

Requestor Info

Requester Name

Requester Email

Program Area

Budget Line Title

Budget Line Number

Speed Chart

Vendor Name

Secondary Email (If applicable)

Has this vendor been approved by Accounts Payable?
YesNo

If no, please attach a completed New Vendor Profile Form

Invoices

Invoice 1 Date

Invoice number

Amount Due

Due Date

Item Description & Business Purpose

Invoice 2 Date

Invoice number

Amount Due

Due Date

Item Description & Bus. Purpose

Invoice 3 Date

Invoice number

Amount Due

Due Date

Item Description & Bus. Purpose

Invoice 4 Date

Invoice number

Amount Due

Due Date

Item Description & Bus. Purpose

Invoice 5 Date

Invoice number

Amount Due

Due Date

Item Description & Bus. Purpose

Are any of these invoices late (more than 30 days past invoice date)?YesNo

If yes, please provide an explanation for accounts payable.

Do you have an electronic copy of the invoices?
YesNo

If no, please put invoice in Ginger's box.
If yes, please attach each invoice (3mb limit).

1:
2:
3:
4:
5:

Is backup documentation required for this purchase? (food form, event details, rosters, gift card form, etc.)

YesNo

If yes, please attach

Last updated: 3/22/2022