LIONS CLUB OF
BEL AIR
Po Box 167 Bel Air, MD 21014
Request For Payment
Date_______________________
To: Club Treasurer
From: ________________________________
Please issue a check in the amount of
$______________, payable to:
Name________________________________________
Address ________________________________________
________________________________________
________________________________________
This expenditure is a proper charge for the
following:
______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Invoices, receipts or other supporting data are attached.
Signed__________________________________________ Approved
by_____________________________________
Committee/Activity_________________________________________________________________________________
-------------------------------------------------------------------------------------------------------------------------------
Approved for payment by
______________________________________________ on
_____________________ (date)
Paid Date____________ Check Number________
ADMINISTRATIVE O
ACTIVITY/SPECIAL EVENT O
Club Treasurer__________________________