Check Copies/Check Status Form

All check copies will be transmitted via Email. Status notification will be returned via reply email unless otherwise requested.

Please provide all information requested below to ensure accurate and timely response.

Type of Request: Check Copy Check Status

Check# AD0

Check issue date (mmddyy):

Issued to (payee name):

Amount of check $:

Requested by:

Department:

Station #:

Phone:

Fax:

Email:

Special Instructions/Notes: