The First Unitarian Church of Hamilton

CHEQUE REQUISITION

(When complete, this form should be delivered to the Treasurer  or Church Administrator)

1.

CHEQUE REQUESTED BY:

Name                                                                       Signature

Date

2.

CHEQUE INFORMATION:

Cheque payable to

Cheque Amount

Delivery Instructions

- leave cheque in the "cheque pickup" folder  in the Church office

- mail cheque to the following person and address:

Name (if different than name on cheque)

Street / Post Office Box

City

Province / State

Postal Code / Zip Code

Special Instructions:

3.

ACCOUNTING INFORMATION:

Description of Goods / Services Purchased

Quantity

Unit Price

Amount

Committee/Account Charged

For Office Use Only

Date Paid

Cheque #