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ATLAS
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CHECK REQUEST FORM
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***Do not type directly in this form. Download and complete the form***
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Please complete with every PTO Check Request - please download form and complete
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Attach Invoice/Receipt (required for payment)
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TO: ATLAS Treasureratlastreas@gmail.com
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***Do not type directly in this form. Download and complete the form***
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Date:
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DHS Group/ Activity:
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Requested by
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Email
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Phone
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Make Check Payable to:
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Check Amount:
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Date Check Required:
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(for vendor payment if applicable)
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Description/Purpose (Please be specific)Enter Amount / Receipts attached
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 $ -
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All checks are mailed
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Payee Name
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Mail To Address Street:
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Mail To Address City
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Mail To Address State:
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Mail To Address Zip Code:
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ATLAS Treasurer's Section
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Check #:
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Date Issued:
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Check Amount:
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