Orange County NC Website
Browse       Search
<br />Check Request / Reimbursement Form <br /> <br /> <br />All check requests/reimbursements must be approved by the Executive Director or the General Manager <br /> <br /> <br /> <br />Date __________________ Total of Check Request $ __________________ <br /> <br />Person Requesting Check/Reimbursement _________________________________________ <br /> <br />Department Charged ___________________________________________________________ <br /> <br />Explanation ___________________________________________________________________ <br /> <br />______________________________________________________________________________ <br /> <br />______________________________________________________________________________ <br /> <br />______________________________________________________________________________ <br /> <br />______________________________________________________________________________ <br /> <br />______________________________________________________________________________ <br /> <br />Make Check Payable to ________________________________________________________ <br /> <br />Street Address or PO Box _______________________________________________________ <br /> <br />City ________________________________ State ______________ Zip ____________ <br /> <br /> <br /> <br /> <br />________________________________________________________________________ <br /> Signature Date <br /> <br /> <br />________________________________________________________________________ <br /> Approval Signature Date <br />Docusign Envelope ID: 177AA06A-30B4-42FF-A85A-78B5A7C51DBE