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CITY OF PUYALLUP Check Request Form Accounts Payable/Finance Department ● 333 South Meridian ● Puyallup, WA 98371 ● (253) 841-5501 REV 02/18 Pay vendor Request W9 for new vendor Reimburse employee (City expenses over $50) Refund non-employee or reimburse other entities for funds collected ATTACH BACK-UP DOCUMENTATION REASON FOR DISBURSEMENT: FUNDING SOURCE Document Number Organization Key (10-digit) Object Code (6-digit) Amount TOTAL AMOUNT OF CHECK $ If additional space required, attach a separate sheet. Do not use an additional Check Request Form I hereby certify that all of the information provided on this form is true and correct to the best of my knowledge Employee signature (required for employee reimbursement) Date: Submitted by: Date: Approved by: Date: CHECK DISTRIBUTION INSTRUCTIONS Electronic Payment. Vendor must have ACH/EFT PAYMENT ENROLLMENT FORM on file (Enrollment to be initiated by Department for new vendors) Mail Check Mail Check with Enclosures (Provide Extra Copy for AP File) Interoffice Check to: PAYEE INFORMATION Name to Appear on Check: Address 1: Address 2: City: State: ZIP Vendor ID or Employee ID: