REQUEST FOR PAYMENT

DATE

__________________                               

MAIL TO

Virginia (Ginger) Kelemen

3112 39th Street

(Check One)

Lubbock, Texas 79413

Federation Expense

Festival Expense

State Festival Expense

Building Expense

1

$

2

$

3

$

4

$

5

$

6

$

7

$

8

$

Pay Directly to Vendor

Total

$

Pay to Officer or Chairman

1

Sign each receipt and attach to back of this request

2

Make request for payment promptly after each activity

3

If expenses of two activities are combined please indicate which expense

applies to what activity

Signature

____________________________________                                                       

Office or Title__________________________________

City & Zip    ____________________________________

Check No.

Phone Number_________________________________

Date of Check