(Formerly Form 10: Special Remittance and Order Form
RETURN TO ACCOUNTING OFFICE, 275 ADMINISTRATION BLDG
Check Request Checklist
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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.
Amount of Request $
(First/Last Name and Address of Vendor)
Payee Vendor's Banner UID#
Index #-Account Code/FOAPL/Amount:
Quantity and Unit Price values must be filled in; the Subtotal and Total values will automatically compute.
Unit Price (Required)
Check this box if you want the Accounting Office to hold check for pickup.
Dept. Mailing Address:
Name of Approver:
Dept. Phone Number (use 7 digits):
Signature of Approver: Date:
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