Check Request Form

DATE

DEPARTMENT

LINE #

Example: 1-####, 9-####, 7-####

Your Email Address

PAYABLE TO

ADDRESS

AMOUNT

DESCRIPTION

CHECK

RETURNED TO ME

MAILED TO RECIPIENT

APPROVED BY

CHECKS ARE ISSUED ON A BI-WEEKLY BASIS

IF YOU HAVE RECEIPTS THAT NEED TO BE SUBMITTED WITH YOUR CHECK REQUEST, PLEASE SCAN AND EMAIL THEM TO ANGIE LYNCH (alynch@fcclife.org) OR SUBMIT THEM TO THE FINANCE DEPARTMENT.

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