Lindenhurst Rotary Club Check Request

Date:_______________

Name:__________________________________  Phone: ______________                       
 (Rotarian Requesting Check)

Requests a check in the amount of:  $_______________ by ____________
       (Date needed)

For:
Committee: ________________           Reimbursement: [    ] (please attach receipt)

Other information:

__________________________________________________________________

_________________________________________________________________

Please make check payable to:________________________________

Check pick up information:

[    ]  Hold the check for me until the next meeting,
[    ]  I need it ASAP, Call when it’s ready, I’ll come and pick it up
[    ]  Please mail the check to this address:  ___________________________
             
 ____________________________________________________________

 ____________________________________________________________
[    ]  I’ll call you to make other arrangements