Check Request Form

Instructions:

Please fill out completely with description of the request.
Attach up to 3 files/pictures/scans of receipts or invoices.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
Questions? Please e-mail our treasurer at treasurerduxboosters@gmail.com.

Check made payable to:

Name of person, organization or vendor to make check payable to.

Check Delivery

How do you want to receive the check? Ex. Send in the mail, at Boosters meeting or make other arrangements for pickup.

Mailing Address

Mailing address, if applicable

Total Amount Requested for Reimbursement/Payment:

Category*

Description/Purpose:

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Date Check Needed or ASAP