<p> NORTHWEST ASSOCIATION OF COLLEGE & UNIVERSITY HOUSING OFFICERS</p><p>CHECK REQUEST FORM</p><p>P Date: Amount Requested: CDN / USD (circle) a y Name to appear on check: e e Address 1:</p><p>I Address 2: n f o r m a City: State/Province: Zip: t i o n</p><p>J Reason for expenditure: u s t i f i c a t i o n</p><p>By submitting this request I certify that all of the information provided on this form is true and correct to the best of my knowledge. My signature denotes that this expenditure related directly to the business of NWACUHO and is an approved and/or budgeted expense.</p><p>A p Requestor’s Requestor’s p Name: Signature: r o v Treasurer’s Treasurer’s a Name: Signature: l Return this form and documentation (original, itemized receipts) to: [email protected] Treasurer Use Only Payment Method: Date: Account: Budget: Bank Reconciliation:</p>