Check Request

First Name *

Last Name *

Email *

Phone

Check Payee Name *

Total Check Amount *

Was a CBCA debit card used for this purchase? *

Enter required value Yes No

Mail the Check? *

Do you want the check mailed? Is so, select "Yes" and provide mailing address below. 

Enter required value Yes No

Address Line 1

Address Line 2

City

State

Postal Code

Payee Email

Payee Phone *

Committee *

Enter required value Art & Wine Bocce Cornhole Executive Board Holiday IT Marketing Oktoberfest Programs

Committee Chair *

Are you the chair for this committee?

Enter required value Yes No

Purpose *

Please list each expense and explain the purpose for each line item:

Description (items purchased) - General Ledger Account (supplies, permits, etc.) - Item $ Amount

Upload Receipt File

If you have the receipt please upload it.

20MB max

Yes, I agree and affirm the above statement * By checking the "Yes" box below, I acknowledge and agree that this action constitutes my electronic signature, and that it is legally equivalent to my handwritten signature. I certify that the information provided is true and complete to the best of my knowledge. I understand that my electronic acceptance is binding and carries the same legal weight as a signed, written document.

Today's Date *