Rev. 2.1.2017

OUR LADY OF VICTORY PARISH CHECK REQUEST

DATE: ____________________________________________________________________________ REQUESTED BY: ________________________________________________________________

CHECK NEEDED BY: ________________________________________________________________ (DATE)

PAY TO: ___________________________________________________________________________

AMOUNT OF: __________________________________________________________ ($____________)

FOR:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

_______________________/____________

APPROVED BY DATE

____________________________________________________________________________________

FOR ACCOUNTING USE ONLY REMARKS: Account # __________________ $_______________________

Account # __________________ $ ______________________

Account # __________________ $_______________________

Account # __________________ $_______________________

Account # __________________ $_______________________

TOTAL $_______________________

€ Please return check to person requesting check

€ Please mail check directly to payee (include full address and contact name)

Check # __________________ Dated ____________