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Form Name:


Used for:

  • Reimbursement of out of pocket expenses for minor supply purchases, postage, telephone, business meals and hospitality costs, and incidental charges.

  • Payment to vendors for utilities, dues and memberships, and subscriptions.

  • Payments for moving expenses, and short term professional service agreements as defined in the policy for Independent Contractors.

  • Replenishing departmental petty cash funds.

Required Fields:

Pay to: Name in which the check is to be made out.
Address: Mailing address or campus box or instructions for pick-up in emergency situations.
Dates: Today's date and the date by which check is to be mailed or made available. (allow 3-5 days for processing).
Originating Dept: Department Name.

Ship to:

Used for instructions to the vendor only.

Items or Description:

Detailed explanation on the purpose for the payment. Show Tax ID and home address here.
Amount(Column): Show total amount of check request. Use $xxx.xx format.
Signatures: Authorized departmental signatures for the account(s) being charged.
Accounting code: Six-digit FRS account number, four-digit subcode.
Account Desc.: Name of the account being charged.
Amount: Amount distributed to the account number listed. Use xxx.xx format.

Documents to Attach:

  • All orginal invoices or receipts justifying requested amount.

  • Copies of signed short-form (under $2,000) consulting agreements.

  • Business Meals & Hospitality form for all employee functions, luncheons, gifts or donations.

  • Any letter or memo which serves as clarification or explanation for the requested amount.

Where to Send:

After proper departmental approvals are obtained, send two copies of the Check Invoice with the original documentation to Accounts Payable. This office will forward to ORA or Purchasing for approval, as necessary.

Special Notes:

  • While this form has many purposes, there are two recurring misuses of this form. (1) When ordering goods or materials in excess of $500, a University Purchase Order is required and (2) Payments for services provided by individuals who are Brown students or employees must be processed through the payroll office.

  • Two copies of the check request are required because one copy is sent with the check. Copies of the backup are not required on the copy.

Check Request download available