East Islip Soccer Club :: powered by Demosphere

*PAYEE INFORMATION:*
Payee Name
Payee Address 1
Payee Address 2
Payee City, State and Zip
Payee Phone Number
Payee E-mail

Is payment to be sent directly to the Payee listed Above? If 'No', check will be left in the EISC box for pickup. Yes No
Does the Payee require proof of EISC 'Not for Porfit' status? Yes No
If so, is this for a one-time or recurring purchase? Yes No

DESCRIPTION OF GOODS AND SERVICES:
Description
Date of Services/Goods Purchased
Quantity Purchase (If Applicable)
Unit Price (If Applicable)
Total Amount

Submission Information (Individual submitting Request)
Name
Title
E-mail
Phone
Coache Name (If different than above)
Team Name/Age Group
Attach Supporting Documentation

Club Approval (For Treasurer Use Only!)
Name
Title
Date Approved
Check Number