Grace Apostolic Church

Check Request Form

Instructions: This form is to be used when a department wants to request funds from the department account for petty cash, projects, or department expense.

PLEASE TYPE OR PRINT

Date: Requested by:

Account code: Amount:

Payable to:

Address:

City: State: Zip:

Payable for:

Support documents attached _______Yes _______No

Requested by: ____________________ Authorized by: _____________________

ACCOUNTING USE ONLY

Approved	Rejected	Check no.	Issued by	Date
					Acct. no.