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:
Fax:
Email:
Action (choose one):
Proof of Payment (check image)
Stop Payment and Reissue	(Reason Below)
Stop Payment
(Unsure of which action to choose? Consult Check Action How To)
Check Information:
Transaction Date:
Voucher or Expense Report Number:
Vendor Name:
Dollar Amount of Check:
Reason for request: