________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________________ _____________________
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
click to sign
signature
click to edit
click to sign
signature
click to edit