Cash Box Request Form

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McKenzie PTA 2015-2016
Cash Box Request Form
Instructions:
1. Complete this form.
2. Submit form to the PTA Treasurer at least 5 days prior to event.
3. Specify number of cash boxes, up to 5, and amount and denominations below.
4. Specify date/time cash box is required.
5.
pickup of cash boxes.
Treasurer will contact individual to arrange
Number of Cash Boxes:
____ Cash Boxes with Cash
_______ Empty Cash Boxes
(see detail below)
Date & Time Required _________________________________________
Cash Detail:
(check all that apply)
Paper Currency
Sub Total $ __________
$ 20 Bills
x _____ = _____
$ 10 Bills
x _____ = _____
$ 5 Bills
x _____ = _____
$ 1 Bills
x _____ = _____
Coin Currency (order in # rolls)
Sub Total $ __________
Quarter Roll = $10.00 x _____ = _____
Dime Roll
= $ 5.00 x
_____ = _____
Nickel Roll
= $ 2.00 x
_____ = _____
Penny Roll
= $ .50 x
_____ = _____
TOTAL $ ___________
Submitted By:
_____________________________ Date submitted: _____________________
Phone:
___________________________
Email:
___________________________________
Committee Name:
______________________________________________________________
Event: ________________________________________________________________________
Questions? Contact
Sarah Fox, PTA Treasurer

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