Authorization for Expenditure of Funds
DATE_____________________
Make check payable to: HOLD MAIL
NAME________________________________________________CSID#_____________________________
ADDRESS_____________________________PHONE#___________________E-MAIL_________________
CITY___________________________ STATE________________ ZIP______________________________
NAME OF ACCOUNT TO BE CHARGED_____________________________________________________
DESCRIPTION
Quantity
Unit
Price
Amount
Additional Information /
Documentation Required:
Minutes- highlight
approval of expenditure
Description/Details of
purchase/service rendered
Date & Name of activity
Attach all Original
Receipts/Invoices
FAILURE TO PROVIDE
THE ABOVE MAY CAUSE
DELAYS IN PROCESSING
Received by:_________________________
Date Received/Mail:___________________
Tax
Shipping
TOTAL
$
Club Advisor: _____________________________________________________________________________
Type/Print Name Signature Ext.
Club Representative: _______________________________________________________________________
Type/Print Name Signature Phone
A.S. Officer: __________________________________________ Date: __________________________
Signature
Dean of Student Affairs: _________________________________ Date: __________________________
Signature
Clerk: ___________ Acct Balance: ___________ Check Number: __________ Check Date: _____________