American Society for Clinical Laboratory Science - PA

RECORD OF INCOME RECEIVED                                                                                  Treasurer Use Only

Return to:          Judy Hoover

                        ASCLS-PA Treasurer                                                                             Date R’ced ____________

                        3 White Oak Blvd                                                                                   Computer Date _________

ALL INCOME MUST BE MADE PAYABLE TO “ASCLS-PA”

Directions for the completion of this form:   Check#:  the sequential number of the check, usually in the upper right corner, not the bank number.  NOTE:  for companies that have one number for the fiscal year and another for the actual check number, use the second number.  Date:  the one on the check, not when you received it. Description:  what is the check paying for?  Payee:  author of the check, usually in the upper left corner, last name is usually sufficient.  If the check is made out to a person rather than ASCLS-PA, that person should endorse the back of the check before mailing it.  Use this for recording a maximum of 12 checks.

Committee:                                                                                                            

 Total:  $_________

Signature:                                                                           

Printed Name:                                                                                     

Address:                                                               

                                                _____________________  

Phone:                                                                                  

Date:                                                                                     

This website last modified 08/20/2006