Unitarian Universalists of Clearwater 2470 Nursery Road Clearwater, FL 33764 727-531-7704 CHECK REQUEST FORM

INSTRUCTIONS:
1.) Fill out and print the form, or print the form and then fill it out.
2.) Attach your receipts.
3.) Get a committee chair or UUC staff member to sign it.
4.) Return it all to the UUC office:
      UUC
      2470 Nursery Road
      Clearwater, FL 33764

Payee:     

---

Address:  

---

                

---

Account #
Committee/Dept                                     Item Description                                     Amount

---

---

---

---

---

---

---

---

Person Requesting
check:       DATE:  

---

Authorized Signature