File Room Check Action Form

This form is to request a Proof of Payment, 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 Wait 30 days from the time the check was vouchered and then submit a Check Action form if needed.
Your Information:  
Name: *
Department: *
Phone: *
Email: *

Action (choose one):


Note: Unsure of which action to choose?

Consult Check Action How To

Proof of Payment (check image)
Stop Payment and Reissue

Reason for reissue:

  • Vendor has not received the check
  • Check was lost/destroyed/ over 60 days old
  • Address is incorrect (provide correction below)
  • Other


Stop Payment

Reason for Void:

  • Dupilcate payment
  • Incorrect dollar amount
  • Payment should not have been made
  • Misspelled vendor name
  • Other



Check Information:  

Transaction Date:

Note: Voucher or Payment Date


Voucher or Expense Report Number:

Check Number:  
Vendor Name:
Dollar Amount of Check: *

Check Handling:

  • Call for pickup
  • Mail to the vendor
    • same address
    • new address


Additional directions or instructions: *
* Denotes Required Field