Fillable Fiscal Agent Signature Sheet (Western Illinois University)

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Fiscal Agent Signature Sheet (Western Illinois University)

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U.S.A. forms for Western Illinois University

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Fiscal Agent Signature Sheet
Use only when changing Fiscal Agent and/or Alternates Date: ______________
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
ACCOUNT #: ACCOUNT NAME:
SIGNATURES
FISCAL AGENT: ____________________________________________________________________________________
(Print or type name) WIU ID# (Signature)
ALTERNATE ONE: __________________________________________________________________________________
(Print or type name) WIU ID# (Signature)
ALTERNATE TWO: __________________________________________________________________________________
(Print or type name) WIU ID# (Signature)
ALTERNATE THREE:_________________________________________________________________________________
(Print or type name) WIU ID# (Signature)
ALTERNATE FOUR:__________________________________________________________________________________
(Print or type name) WIU ID# (Signature)
Previous Fiscal Agent's signature:_____________________________________________________________________
MONTHLY REPORTS: (besides the fiscal agent, list name and email of others who should receive the monthly reports)
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Fiscal Agent Signature Sheet (Western Illinois University)

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Completed 9 February 2021

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