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Check Request Form
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Amount Requested:
Date Requested:
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Make Check Payable to:
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Date of Check:
Check Number:
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Requestor's Modern Name:
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Address:
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Phone:
E-mail address:
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SCA Name:
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Purpose of this request:
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Attach all receipts to this form. Circle the amount to be paid on each receipt.
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Payments will not be made until proper receipts are submitted.
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For the Exchequer's Use Only
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Expenses
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OAARFRTotal
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1
Advertising
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Equipment Rental & Maint.
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Fees & Honoraria
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4Food
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General Supplies
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Insurance (Non-SCA)
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Occupancy & Site Charges
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Postage & Shipping
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Printing & Publications
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Telephone/ Internet Video
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Travel (Gas, Tolls, Airfare)
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Other Expenses (itemize on back)
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TOTAL EXPENSES (Lines 1 to 12)
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Approved by:
Approved by:
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Financial Committee Member
Financial Committee Member
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Notes:
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