Cash Remittance Form

Account Number: _________________________________________

Object Code:  _____________________________________________

Amount: ___________________        Description: __________________________________________

Amount:___________________        Description: _________________________________________

Amount: ___________________       Description: _________________________________________ 

Amount: ___________________       Description: _________________________________________

Check Total: _____________________

Cash Total: ______________________

TOTAL DEPOSIT: _____________________

Please contact the cashier at X5570 for exchange rates if you have Canadian Currency or checks to deposit.


Signature:  ________________________________________________     Date: ____________________