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Check Request Form & Procedures

Payment by check request will be made with an orginal invoice. The invoice is to be obtained at the same time as the item. Petty cash receipts must be attached to the check request. These regulations also apply to purchases under $50.00 that are reimbursed through the Bursary. Use the purchasing card instead of petty cash unless the vendor does not accept the card.

The Service Request Form/Goldenrod (PDF Format, Word Format) will be used as a Check Request.

  1. SERVICE REQUEST (MARK ONE):
    Place an "X" in the Check Request block or
    place an "X" in the Petty Cash/Reimbursement block.
  2. ACCOUNT NUMBER: Enter the eighteen digit account number to be charged. If the request is to be charged to more than one account number, type "SPLIT CHARGE" and list the account numbers and the total amounts to be charged to each account number on the first lines of the description section.
  3. DEPARTMENT NAME: Enter the department name.
  4. DIRECT INQUIRES TO: Enter the name and phone number of the contact person.
  5. DESCRIPTION AND SPECIFICATIONS: Enter the invoice number, date and amount. Below each invoice, give an itemized description of the items purchased on the invoice(s). This is necessary to enable the Purchasing Department to report purchases to the State. If the number of items to itemize is greater than 25, you will be allowed to attach copies of the invoices IN TRIPLICATE.
  6. QUANTITY AND UNIT OF ORDER: Enter the quantity and unit amount of each item.
  7. UNIT PRICE: Enter the unit price of each item.
  8. EXTENDED PRICE: Enter the extended price of each item.
  9. PAGE TOTAL: Enter the total dollar amount of items on this page.
  10. GRAND TOTAL: Enter the total dollar amount of the check request.
  11. KNOWN SUPPLIERS: Enter the name and address of the vendor or person to be paid. If payment is to be made to a person, also include the Social Security number. For petty cash reimbursements, enter the name and social security number of the person to be reimbursed. Do not put the name of the store where the item was purchased. This could result in payment being made to the store.
  12. RECEIVING DOCUMENT: The person receiving the items must sign and date the form certifying the items were received in good condition.
  13. CHECK REQUEST APPROVAL: The request must be signed and dated by an authorized person certifying that payment will not overdraw the account. If sufficient funds are not in the account, a budget amendment is to be prepared and attached to the check request.

All checks will be mailed unless otherwise indicated on the request.

Foundation accounts are handled through the VSU Foundation.