The University of Memphis
Check Request
(Formerly Form 10: Special Remittance and Order Form)
RETURN TO ACCOUNTING OFFICE, 275 ADMINISTRATION BLDG
Check Request Checklist | Click here for online help.
Send a duplicate form to the Accounting Office when remittance in advance is required, and it is impossible to obtain an invoice. Please attach any additional copies to accompany check if needed.

Date:
  Amount of Request $  (Automatically Computed)

Payable To: (First/Last Name and Address of Vendor)     Payee Vendor's Banner UID#:
Employee Non-Employee






PO#:
 
Index #-Account Code/FOAPL/Amount:
Quantity and Unit Price values must be filled in; the Subtotal and Total values will automatically compute.
Quantity (Required)
Description
Unit Price (Required)
Subtotal
TOTAL
Check this box if you want the Accounting Office to hold check for pickup.
Contact Name: Phone:
 
Department:

Dept. Mailing Address:


Prepared By:


Name of Approver:



Dept. Phone Number (use 7 digits):
(901)
Signature of Approver:                                 Date:                  

_________________________________       _______________

The University of Memphis, one of the Tennessee Board of Regents institutions, is an Equal Opportunity/Affirmative Action University.