Petty Cash Reimbursement Receipt

Vendor *This question is required.

Request Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Description of Purchased Items and Intended Use *This question is required.

Purchased By Name *This question is required.

Purchase Amount *This question is required. This question requires a valid currency format.

The Department budget will be charged at the time this form and the accompanying original receipts are presented to the cashier.

Department *This question is required.

Org Code *This question is required.

Approved By Name *This question is required.

Acct Expense Code *This question is required.

Approved By Title *This question is required.

Activity Code

Directions

Check the information you've entered on the form above to confirm it is accurate and complete.
Click "Next" to preview the form.
If the form is ready click the "Save to PDF" button.
Download and print a copy of the form
Sign and date the form
Obtain department approval signature
Staple receipts to the form and take it to the cashier office for reimbursement