Florida University - Petty Cash / Change Fund Request
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1PETTY CASH/CHANGE FUND REQUEST FORM
This form is used to request the establishment of a Petty Cash or Change Fund from Controller’s Office.
Please complete the form below and submit to the Controller’s Office, CSC 420. For assistance or
questions regarding this form, please contact Accounting and Reporting Services at Ext. 7-2550
Custodian Name: _____________________________
Date: _______________________
Title: _______________________________
Telephone #: ________________
Email address: _______________________
Activity Nbr. to be charged: _________________
Cost Center
Activity Nbr:
Cost PID:
Task:
Budget Ref:
Optional fields, use if applicable:
Cost PID - To track expenses related to faculty allocations.
Task -
To track expenses that have a similar purpose as assigned, for example Critical Investments.
Budget Ref - To track specific years for Financial Aid and COM only.
OR
Project:
Fund:
Optional field, use if applicable:
Fund - To be used for Cost Share only
Please answer the following questions:
1. What is the name and purpose of this fund?
2. How much are you requesting?
$_____________
Forms that are used in conjunction with this request are as follows:
1. Unencumbered Payment Form– Used to initiate petty cash funds and to replenish them.
2. Petty Cash/Change Fund Custodian Acknowledgement – signed by the custodian at time
of cash disbursement. This person will be responsible for the petty cash fund
3. Petty Cash/Change Fund Reassignment – Used to reassign a petty cash fund to another
employee.
4. Petty Cash/Change Fund Cancellation – Used to close a petty cash fund.
Signature of Dept Budget Manager:___________________________________________
Petty Cash Request Form Rev 7-23-2013
Page 1
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