__________________________________________________ __________ ____________________________________________ _________
MONTANA STATE UNIVERSITY BILLINGS
Account and Signature Authorization Change Form
(For Student Organizations)
This form is to be used for signature and authority changes on existing
Indexes and to request a new index for student organizations only.
To be completed by the Student Life/ASMSUB Office:
_____ Request a New Index (Please indicate type of Index) _____ Change Fund Controller (Please indicate type of Index to change)
Agency Account Index Number (Index begins with 601xxx) Agency Account Index Number (Index begins with 601xxx)
Name of New Index requested: _________________________
(Name should be limited to no more than 35 characters)
Student Fee Account Index Number (Index begins with 630xxx)
Index Number: __________ Index Name: ____________________
Student Fee Account Index Number
(Index begins with 630xxx)
Name of New Index requested: _________________________
(Name should be limited to no more than 35 characters)
Index Number: __________ Index Name: ____________________
To be completed by Fund Controller(s):
Please approve the individuals listed below, of which at least one is an MSUB faculty or staff member, as duly authorized to sign documents for the
above-name account. By their signatures, the Fund Controllers acknowledge their responsibility to ensure that the index maintains a positive
cash balance.
Please state the number of signatures required on each document: __________.
Advisor Student
_________________________
(Printed Name)
_________________________
Signature
__________
Date
____________________
(Printed Name)
_______________________
Signature
_________
Date
_________________________
(Printed Name)
_________________________
Signature
__________
Date
____________________
(Printed Name)
_______________________
Signature
_________
Date
____________________
(Printed Name)
_______________________
Signature
_________
Date
____________________
(Printed Name)
_______________________
Signature
_________
Date
Required Signatures:
Director of Student Life Date Vice Chancellor of Student Affairs Date
*Please forward the completed form to the Financial Services Office McMullen Hall Room 309*
