NHLA
NEW HAMPSHIRE LIBRARY ASSOCIATION
PAYMENT FORM
Date:
Payment Amount:
Payment is for the following activity: _____________________________________________________
PLEASE REMEMBER TO ATTACH RECEIPT(S) OR SUPPORTING DOCUMENTATION TO THIS FORM
Make check "PAYABLE TO": (Name)
Send check to: (Address)
Send check "ATTENTION OF": (If different from payee)
Payment authorized by: Name
NHLA Title
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Pay from:
	Bank/Broker Name	Bank/Broker Acct#	Fund Name	Acct. Classification	Amount
NHLA Treasurer:				Date:
Treasurer's Notes:
- - - - - - - - - - - - - - - - - - - - - - - - - - - (Forward to Accountant) - - - - - - - - - - - - - - - - - - - - - - - - -
Accountant's Notes:
INCORPORATED 1889