Application for Petty Cash or Change Fund

Timer

--:--

* = required field

Some content may be updated based on selection

Application for Petty Cash or Change Fund

Office of Student and Financial Services
Box 20419
Savannah, GA 31404
Telephone 912-358-4044
Facsimile 912-358-3670
Email cashiers@savannahstate.edu

ACCOUNTING USE ONLY

Request For: (Complete One)

Petty Cash Fund

Check No.

Change Fund

Date

Issued By:

First Name

Last Name

Name of Department

Account No.

Name of Custodian

First Name

Last Name

Title

Employee ID

Last Name

First Name

MI

Email

Phone

Mail Box #

Department

Description of Need for Fund

Please describe need for fund

Location of Fund

Building

Type of Storage

Room

Other

This fund and responsibility, therefore, is issued to the named custodian and cannot be transferred. If, for any reason, a fund is no longer needed or there is a change in the custodian, this fund must be turned in to the university cashier, thereby terminating the responsibility of the custodian. If the need continues, a new fund will be issued upon application.

I accept the above stated cash fund with the understanding that I am personally responsible for the proper safekeeping and use of said funds. It is further understood that I will be personally liable for all shortages and uninsured losses.

Signature of Custodian

First Name

Last Name

Date

I approve the designation as custodian of the above stated cash fund. It is further understood that I will be jointly liable for all shortages and uninsured losses.

Signature of Dean, Director, or Department Head

First Name

Last Name

Date

Please wait for files to finish uploading