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Check Action Request Form - Fillable.docx 2026

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The document is a CHECK ACTION REQUEST FORM used to request the voiding or re-issuing of checks. It requires details such as business name, contact information, check number, and type of request. Instructions are provided for submitting the form based on whether the check is older than 30 days or if the physical check is available. The form includes a confirmation statement regarding authority over the check and outlines liability terms.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Business Name or Payee Name in the designated field. This identifies who the check is for.
Optionally, provide your Email and Telephone Number for any follow-up communication regarding your request.
Fill in the Location/Site ID if applicable, followed by the Amount of Check you are requesting.
Select the type of request: either 'Void Request' or 'Re-issue Request'. Make sure to check the appropriate box.
Provide your Contact Name and Check Number for reference, along with the Money/Express Code if available.
In the Check details section, follow the instructions based on whether you have a physical check or not. If you do, mail both the form and check to EFS Check Clear at the specified address.
If you do not have a physical check or it is older than 30 days, email your completed form to efs.checks@wexinc.com.
Finally, sign and date the form to confirm your request before submitting it through your chosen method.

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Versions	Form popularity	Fillable & printable
2020	4.7 Satisfied (30 Votes)
2018	4.4 Satisfied (32 Votes)

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What is a check request form?

Purpose. Used to request payment to vendors/companies and individuals, for services rendered, honorariums, supplies ordered, subscriptions, membership dues, workshop/seminar/conference registrations, use of facilities, etc.

How to fill out a check form?

Before you get started, make sure to use a blue or black gel pen to keep the information clear and help protect yourself against fraud. Date the check. Tell the bank who to pay. Write your payment amount in numbers. Spell out your payment amount in words. Use the memo field. Sign the check.

Can an EFS check be cancelled?

Please call the number on the draft to have it voided or re-issued. PLEASE NOTE: If you do not have the physical check or legal copy, there is a required waiting period of 30 days before checks can be voided.

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How to fill out a check request form?

The Check Request Form consists of various fields necessary for collecting payment information and documenting requests. Date of Request: Enter the date the request is being submitted. Dept Name: Specify the department requesting the payment. Check Due By: Indicate the date by which the payment is needed.

How to do a check request?

Check Request Form Policy All requests need to have the original documentation. If a copy needs to be mailed with the check, then a copy of original MUST be attached to paperwork. If the check needs to be mailed specifically to someones attention, then a pre-addressed envelope MUST be attached to paperwork.

How to fill a cheque request form?

Cheque Book Request Letter Format Address. The senders and the receivers addresses should be mentioned in the cheque book request letter. Date. The date is one of the most important things when you write the request letter. Salutation. Subject. Main body. Signature.

What is a check request process?

Check requests are user-initiated requests for invoice payment. These requests contain information that populates a manual invoice within Accounts Payable. Invoice Number, Invoice Date, Invoice Total, Vendor, and Pay To data can be entered on a check request, as well as check total and distribution detail amounts.

Check Action Request Form - Fillable.docx 2026

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