Instructions To Complete Forms

Copies of these forms are available on the Financial Services Forms Page for University Officials. Attached are samples of properly completed petty cash forms. Please follow the numbered instructions  which correspond with the numbered notations on each sample.

Request to Establish Petty Cash Fund
(Click to Open Example in a Seperate Window.)

1. Fill in the name of the department requesting the fund and the amount  requested. The fund amount should be no more than the department's monthly usage or a maximum of $100.
2. Fill in the name and telephone number of the person who will be responsible  for the fund and an alternate. Also indicate the exact location where the fund and records will be kept.
3. The form is to be signed by the custodian and the Dean/Department  Head.

Change of Petty Cash Custodian
(Click to Open Example in a Seperate Window.)

1. Fill in the name and telephone number of the new custodian and alternate.
2. The outgoing custodian; the new custodian and the Dean/Department  Head must certify that the fund was counted and reconciled to the authorized  amount.

Payment from Petty Cash Fund
(Click to Open Example in a Seperate Window.)

This form is used when a cash advance is given for a purchase or when  a receipt or a paid itemized sales ticket is not available

1. Enter the amount of the total purchase.
2. Enter a detailed description of the purchase.
3. The person receiving the cash advance or reimbursement must sign.
4. The custodian is to enter the account number to be charged and sign  the form.

Petty Cash Reconciliation Statement and Disbursement Report

1. Fill in department name and location.
2. The custodian must sign, date, and fill in the account number to be charged.
3. The authorized signature for each account being charged is required.
4. The report period is from the oldest dated receipt to the newest dated receipt.
5. Enter the amount of fund.
6. Enter a description of each purchase and the amount per the cash receipt.
7. This is the reconciliation section. Enter the total disbursements  and subtract from the amount of the fund. This leaves the amount of the petty cash on hand.
8. The count of the actual cash remaining must agree with the petty cash on hand.

Check Request Form

1. Date - Enter date document is being prepared.
2. Department Name - enter the name of the department that is responsible for the payment.
3. Originator Name/Phone # - Enter the name and phone number of the person who is to be called if there is a question or problem concerning  the payment.
4. Authorized Signature - Only a person who is authorized on the account  being charged can sign. If more than one account number is being charged there must be an authorized signature for each account.
5. Vendor Identification # - This space does not need to be filled in for petty cash reimbursements.
6. Vendor & Address - Enter the name of the fund on the first line. The address should be in care of the custodian at his/her office location.  THE VENDOR NAME AND ADDRESS CAN BE ONLY FOUR LINES AND NO MORE THAN 30 SPACES A LINE. Anything beyond these limits will not be printed on the check.
7. Account Number - Enter the account number to be charged including  the four-digit object code. Up to 16 different account numbers can be used.
8. Amount - Enter the total amount to be charged to the account number  on that line. Do not enter an amount on a line that has no account number.

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