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AGENCY ACCOUNT REPORT FORM
The Office of Student Life requires this form be completed biannually
by all student organizations that hold off-campus agency accounts.
Organization: ________________________________
Advisor: ____________________________________
Bank/Credit Union: ___________________________
Number of signatures required on check: _________
Academic Year: ____________
Phone: ___________________
Account #:_________________
Person(s) authorized to sign on account:
As the official organization advisor, I agree to update this agency account
information should it change during the course of the fiscal year listed above.
Organization Advisor Signature Date
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