Voucher Check Requisition Form
Not for Employee Reimbursement
DEPARTMENT NAME
Check Attachments:
Yes
No
Indicate Wire Transfer
Yes
PAY TO:
(
$ AMOUNT)
SOCIAL SECURITY NUMBER:
(FOR INDIVIDUALS
)
ADDRESS:
PURPOSE:
PeopleSoft Chartfield:
Account
Fund
DeptID
Program
Class
Project/Grant
%
*If splitting charge between two accounts please provide additional account number and percent distribution:
Account
Fund
DeptID
Program
Class
Project/Grant
%
REQUESTED BY (PRINT NAME):
EXT:
DATE:
REQUESTOR'S SIGNATURE:
EXT:
DATE:
APPROVED BY:
EXT:
DATE: