Foundation Check Request Form

FOUNDATION

CSUN FOUNDATION

TEL NO: (818) 677-4657

FAX NO: (818) 677-4823

MAIL DROP: 8296

Check Request Form

Date:		Reference #:
Amount: $
Amount in Words:

Payee Name:

Mail Drop:

Payee is:

FACULTY

STATE/UNIV CORP EMPLOYEE

CSUN STUDENT

OTHER

Payee Address:

Brief Explanation of Expenditure: (must relate to account purpose)

Charge to Fund Name:

ACCOUNT:	FUND:	DEPT ID:	PROGRAM:	CLASS:	PROJECT/GRANT:

NACUBO Classification:

INSTRUCTION

RESEARCH

PUBLIC SERVICE

ACADEMIC SUPPORT

STUDENT SERVICES

INSTITUTIONAL SUPPT

SCHOLARSHIPS

(PLEASE CONSULT YOUR MAR/FINANCIAL MANAGER TO ENSURE THESE BOXES ARE CHECKED CORRECTLY)

This Check Should Be:

MAILED TO PAYEE

HELD FOR PICKUP

CSUN MAIL DROP

Questions? Please call:
NAME OF CONTACT PERSON:	PHONE:	EMAIL:	MAIL DROP:

Signature: ______________________________________________
Print Name:	Date:
Signature: _______________________________________________
Print Name:	Date:
Signature: _______________________________________________
Print Name:	Date:

Reviewed By: __________________________________

Check Received By: __________________________________

IMPORTANT: ORIGINAL RECEIPTS AND INVOICES MUST ACCOMPANY EACH CHECK REQUEST. A W9 FORM MUST BE SUBMITTED FOR ALL NEW VENDORS. AN INDEPENDENT CONTRACTOR FORM MUST BE SUBMITTED WITH EACH REQUEST FOR SERVICES PROVIDED BY AN INDIVIDUAL OR UNINCORPORATED COMPANY. FOR REIMBURSEMENTS FOR EVENT RELATED EXPENSES, PLEASE INDICATE THE PURPOSE OF THE EVENT, THE DATE, A LIST OF ATTENDEES, AND ATTACH A COPY OF THE INVITATION/FLYER. FOR HOSPITALITY EXPENSES OVER $500, COMPLETE THE HOSPITALITY EXPENSE FORM. FOR AN INVOICE PAYMENT REQUEST, PLEASE MARK THE INVOICE "RECEIVED" WITH SIGNATURE AND DATE. FOR ALL SCHOLARSHIPS AND STUDENT AWARDS, PLEASE USE THE DEPARTMENT REQUEST FOR FUNDS FORM FOUND ON THE FINANCIAL AID WEBSITE. (1/10/05)