Resources
CHECK DISBURSEMENT REQUEST FORM
*All fields are required to be filled out by the Program Chairperson.
Date Submitted To Treasurer:
Program:
Chairperson:
Contact Information:
Check payable to:
Requested Amount:
Item(s) that are being purchased with check:
Are you
OVER
or
UNDER
your estimated
budget cost for this request? (please type):
If answer above is
OVER
, please explain the
reason:
Additional Comments:
*The following fields are to be filled out by the Rec Council TREASURER
Approved On:
Paid for with check#:
Date check(s) given or paid:
Signature:
