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Check Requisition & Expense Disbursement Process

Requestor Information

Requestor Name *

Department Client Entity *

Company Name / Department Name

Requested Date *

Phone *

Email *

Payee / Transfer Type

Vendor / Payee ID

Enter the account number (if known)

Select One: *

Internal Payee / Cross-Account Transfer

External Payee

Payee Name *

Which entity or person is the request for?

Payee Address *

Payee Phone Number *

Payee Email *

Authorized User Details *

Who authorized this transaction?

From Bank Account Name *

From Bank Account ABA/Routing *

From Bank Account ABA/Routing # (Reconfirm) *

Payee Bank Account # *

Payee Bank Account # (Reconfirm) *

Payment Details

Invoice Date *

Amount Requested (USD) *

Payment Due Date *

Reason for Payment

Invoice Number(s) *

Enter the referenced invoice numbers

Account / Coding Information

Entity Account to Charge

Enter the entity account name (if known)

Expense Account Code

Enter the expense account code (if known)

Project Code

Enter the project code (if known)

Supporting Documentation

Upload file

Please upload all required supporting documents directly into this EGP Check Requisition & Expense Disbursement Process Form; multiple files may be submitted at once. Requests submitted without supporting documentation will not be approved

Notes *

Use this section to provide a brief summary of the request and include any additional details that may help the reviewer understand the purpose, context, or urgency. Examples may include special circumstances, deadlines, exceptions, or clarifications that are not covered elsewhere in the form.

Authorization & Approval

Requested Date *

Requested By *

Clear

Signature