Petty Cash Request Form

Pay to the Order of: _________________________________________

Payee Address: _____________________________________________

Amount: __________________             SSN/TIN: ________________

Account Number(s): ___________________________________________

Distribution:  US Mail / Pickup / Campus Mail (________________)

Purpose:  Travel Advance/Membership Dues/Honoraria/Services/Subscriptions

Explanation: (Who, What, Where, When, Why) ___________________

Approval:  ________________________________  Date: ______________

NOTE:  Checks are printed every Friday by Noon for payment requests received by Tuesday at 4:00 p.m.  An exception would be if the check request indicates a check is not required until a later date; the check would then be printed on the Friday immediately preceding that date.

Requests for reimbursements to employees will be paid by direct deposit on Monday if the employee's salary is paid by direct deposit.

If the employee's salary is paid by check, reimbursements will be paid by check as well.