The accounting department uses this form at Hardy, Miller, and Associates.
Hardy, Miller, and Associates
Check Request Form
Department Name: Personnel
Date 614
Address: 201 E Suite 10
Date Needed: 619
Phone 3-095
Payee Name and Danto Smith
Address: 91 Moplo St
Saracito, CA 98351
Disposition of Checks: Mail to Payee I Return to Department Pick Up
Account Number Account Name Description of Disbursement Amour
55819 Professional Growth In-house seminar 385.00
Receipt Included? Yes No
Check Total 385.00
The payment is to be used for (please check one of the following squares to
complete request)
Services Rendered Vendor Payment Reimbursement Travel Advance
I cortity that this payment is consistent with the purpose of the account and applicable
expenditure policies of Hardy, Miller, and Associates
Controller's Use Only
Requested by Bolle Richardson
Approved: Becky Porce Account #: 56819 Approved by: Jamie Owen
Date: 1617
Check #01132
How is the payment to be used?
A. In-house seminar
B. Personnel
C. Professional growth
D. Reimbursement