REQUEST FOR PAYMENT FORM

Recipient (TWST Member receiving funds) __________________________________________

Form of Payment (Cash / Check / Money Order) _____________________

Check made out to: __________________________________________

Amount: ______________________

Date: ______________________

Purpose of expenditure:

Budget line item covering this expense: __________________________________________

Requested by: __________________________________________

Approved by: __________________________________________

Second Approval if amount over $1,000 __________________________________________