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    Date

    Person/Member Requesting Check

    Phone Number

    Payee Name

    Payee Mailing Address

    Amount

    Memo

    Please Check Applicable Box (or boxes) CommitteeProgramFund

    Reason for Distribution

    Will Check be Mailed or Picked Up? MailedPicked Up

    Please expect that checks will be prepared by the 1st and the 3rd Friday of each month. Required signatures will be completed on the following Monday at the Rotary meeting before the checks are distributed. For urgent funds, checks will be prepared upon request with this completed form. The requesting member will be responsible for acquiring signatures from authorized signers. Thank you!

    Please expect that checks will be prepared by the 1st and the 3rd Friday of each month, Required signatures will be completed on the following Monday at the Rotary meeting before the checks are distributed. For urgent funds, checks will be prepared upon request with this completed form. The requesting member will be responsible for acquiring signatures from authorized signers.

    Thank You!