Request for Reissue of Missing Accounts Payable Check

This is the standard form used to request reissue of a missing accounts payable check. Once the form is filled out, it should be delivered or faxed to Financial Services. For assistance with this form, please contact Accounts Payable at 501.569.8617.

Request for Reissue of Missing Accounts Payable Check

Date
: The date of the request.

Name
: The person attesting that the check was not received.

Check Number
: The check number of the missing check.

Check Amount
: The amount of the missing check.

Check Date
: The date the missing check was issued to the Payee by UALR.

Payable To
: Who the check was issued to.

Address
: Where the reissued check should be sent.

Payee’s Signature