| ACTIVITY OR WELFARE FUND |
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| PAYMENT VOUCHER |
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| Voucher No. __________ |
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| Vendor Name: ___________________________________________________ |
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| Address: ___________________________________________________ |
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| Invoice No.: |
__________ |
Date: |
__________ |
Amount: |
$__________ |
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| For Goods Received or Services Rendered (Explain Expenditure) |
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| Payment Requested and Certified Correct |
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| NAME |
TITLE |
DATE |
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| Payment Approved: |
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NAME |
TITLE |
DATE |
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| Paid by Check No. ____________ |
Date _____________ |
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| NAME |
TITLE |
DATE |
| INVOICE, RECEIPT OR STATEMENT MUST BE ATTACHED. |