Check Request For Petty Cash Replenishment
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1CHECK REQUEST for PETTY CASH REPLENISHMENT
Use this form to replenish Petty Cash. Staple receipts to the back of this form and submit to the Accounts
Payable Office. Please keep a copy for your records.
Check Due Date _____/_____/_____
Date ___________________
Presbyterian College
Check Payable to
Amount $ _______________
Department/Office __________________________________________________________________
Purpose of payment: Replenish Petty Cash
Account Distribution
Petty Cash Reconciliation
Fund
Orgn
Account
Amount
1
Original Amount
(Not Required)
of Fund
$
2
Total Amount of
$
Receipts Attached
$
3
Amount of Cash
$
on Hand
$
4
Total of Lines 2 & 3
$
$
$
Compare Line 4 to Line 1
$
If not equal, explain below:
$
$
$
Requested by ______________________________________________ Extension __________________
___________________________
____________
___________________________
____________
Requisitioner Signature
Date
Department Head Signature
Date
___________________________
____________
Officer Approval
Date
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Parent category: Business