Request for payment check payable to

SCHOOL DISTRICT OF SOUTH MILWAUKEE
REQUEST FOR PAYMENT


Check payable to:

Address:

City/State/Zip:
Social Security Number:

(Must be provided when payment is to an individual for services. Also, attach

completed Form W-9 from individual.)

Amount Requested:
For:

Account Number Amount

Requested by: Date: _____________

Approved by: __________________________________ Date: _____________

Business Manager: __________________________________ Date: _____________

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This form is used to request payment of purchases/services when the use of a purchase order is not appropriate. RECEIPTS, INVOICE, OR INFORMATIONAL DOCUMENTATION must be attached.

NOTE: Request for payment of itemized travel expenses should be made on the green Expense Report form.

Rev 11/11