Microsoft Word - cheque_request_form.doc
ROTARY CLUB of BURLINGTON LAKESHORECHEQUE REQUISITION FORMSend to payments@, attach receiptsSend completed request to TreasurerDate of request:xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxCheque payable to:Mailing address:3429001860550034290018224500Amount of cheque: _________Committee to be charged: Mail directly:or Deliver to: ______________________________________Particulars:3429001860550034290018224500Authorized by: Once cheque is complete notify:___________________________________________________________xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxFor Treasurer’s use only:Date Paid: Cheque Number: Amount: G.L. Account Charged: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx ................
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