File Room Check Action Form

This form is to request a Proof of Payment, Cancelled Draft, or Stop Payment for non-payroll checks. If you would like a hard copy of this form, print the page before clicking "submit" at the bottom.

Before you fill out the form:

Has it been 30 days or more since the check was vouchered?

Answer Action
Yes Continue filling out the form.
No and the check was for under $1000.00 Wait 30 days from the time the check was vouchered and then submit a Check Action form if needed.
No and the check was for over $1000.00 Contact the File Room

Your Information:  
Name:
Department:
Phone:
Fax:
Email:
   
Action (choose one):  
Proof of Payment
Cancelled Draft (check over 1 year old only)
Stop Payment Call the File Room

(Unsure of which action to choose? Consult Check Action How To)
   
Check Information:  
Transaction Date:
Voucher Number:
Vendor Name:
Dollar Amount of Check:



Reason for request:

 


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