check request

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18900 E. HAMPDEN AVENUE AURORA, CO 80013 303.628.7200

PURCHASE REQUISITION/CHECK REQUEST

All fields on this form are required, including signatures.

STEP 1: REQUEST SUBMISSION

Note: This form must be submitted to and signed by your Ministry/Pastoral Overseer before submitting to the Administrator. Any supporting documentation or price quotes related to this request must be attached. Campus

AURORA DENVER

Ministry

Requestor Name

Requestor Phone and/or Email

Requestor Signature/Date

Overseer or Pastoral Overseer Signature/Date

Reason for Expenditure; please explain fully:

Requested Amount

$

STEP 2: APPROVAL (Office Use Only)

Note: Purchase requests are approved once per week. Approved Amount

$

Administrator Signature/Date

Purchase Order Number Assigned

STEP 3: PAYMENT

Note: Receipts, invoices, packing slips or other proof of purchase must be attached to the top of this form for payment. Return with attachments to the Administrator. Payment Amount

$

Payment Method

MAKE CHECK PAYABLE TO:

Date Required (for check payments in advance)

Church Credit Card Check in Advance Reimbursement Invoice

Name

Comments or Special Instructions:

Address

City, State ZIP

Phone Number

STEP 3A: SUPPLEMENTAL APPROVAL

Note: Overseer or Pastoral Overseer AND Administrator signature required if payment amount is greater than approved amount. This approval must be obtained prior to incurring the expense. Overseer or Pastoral Overseer Signature/Date

Administrator Signature/Date

This purchase request and approvals expire three months from the date of issue. REVISED 12/2011