request for payment
forward original only
Canadian forces base, Winnipeg Manitoba
purchase of supplies, equipment and services
date
1.	It is requested that the following supplies, equipment or services (except merchandise for resale) as listed hereunder be
purchased/paid on behalf of	and the cost charged to
(Mess or Institute)
.
(Account Number)
2.	Use this block for:
a.	request for payment/payment/food services; and
make cheque payable to:	amount	PO No/REQ No
b.	request for payment of special compensation.
number	rank	name	particulars	amount	cheque no
3.	Function or purpose for which required:
4.	Certified that the above named individual is entitled to payment at the rate shown (applicable to payments for special compensation).
5.	Special instructions (if any)
6.	Minute Authority	Date	Item No
(Authorizing Officer)
(Chairman of Committee)
(Title)
(Committee)
7.	Notes on completion:
a.	it is mandatory that the minute authority be indicated and that the correct authorizing officer sign this form. Failure to follow these instructions will result in this form being not actioned.

Reproduced by Master Seaman Rivard (08/01)

REQUEST FOR PAYMENT

Master Seaman Mario Rivard

2001-11-30

17 Wing