====================================================================== Artemis Society International CHECK REQUEST ====================================================================== Date of request: Check request: # (for Treasurer's use only) Amount: $ Requested by: Employee ID: Payable to: Send check to: Address: City: State: ZIP: Country: Explanation: (Attach receipts) Signature: ____________________________________ Date: _______________ ====================================================================== SUPERVISOR Approved [ ] Disapproved [ ] If disapproved, reason: Signature: ____________________________________ Date: _______________ Type Name Here ====================================================================== TREASURER Contract: # Cost Charge: # Approved [ ] Disapproved [ ] If disapproved, reason: Bank: Account: Check Number: Date of Check: Date check sent: Comment: Signature: ____________________________________ Date: _______________ ====================================================================== Please print this in a monospaced font and send it to your supervisor. ====================================================================== CRF001 2/26/98