Check No:  __________

Delaware Saengerbund and Library Association

Request for Payment

Activity to be charged:  ___________________________________________________

To:  DSB Treasurer                                                           Date:  _______________

From:   _________________________________________________________________

(Board Member or Activity Chairman)

Please draw check for the following:

                                     Payee and Address                                                  Amount

                  _______________________________________________   $ ____________

                  _______________________________________________

                  _______________________________________________

                  _______________________________________________

Invoice Number:  _________________

*Explanation of Payment:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

* Attach at least one copy of the invoice.  If payment is for supplies or materials, then the copy of the invoice must indicate receipt of goods with signature of receiver and the date receipt.  Highlight payment if required.