Email: Text THIS FORM MUST BE FILLED OUT, PRINTED, AND SIGNED BY THE CLUB/ORGANIZATION PRESIDENT OR TREASURER ONLY Contact Information Club/Organization: Date: Amount of Check: $ Fund: SAF | SGA If SGA, fundraising money?: yes | no Payable to (Name): U.S. citizen?: yes | no Email Address: Phone: Mailing Address (include zipcode): PSU ID Number or Fed-ID Number: Is payee a PSU employee?: yes | no Purpose of Check (be specific). Date(s) of Event/Check is needed (if applicable): Officer Information Name: Email Address: Phone: Signature: Position/Office held (check one): President | Treasurer Is original backup documentation attached (receipt, quote, and/or contract)? Yes | No Note: Check processing requires a minimum of 3 weeks from the date received by Student Affairs. If all information on this form including backup documentation is not provided, your request will not be processed. FOR OFFICE USE ONLY Check one: ERS | IDCC | SRFC | Advance Processing date: Cost Center/Budget: Balance of fund prior to check: SGA: $ SAF: $ SGA Funds Bookkeeper Signature: SGA Treasurer/President Signature: Rationale if not approved: