Updated 11/2/2017
PETTY CASH REQUEST FORM
All Receipts and Signatures must be original
Petty Cash is limited to $100 per person, per index, per day
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REQUESTS:
Petty Cash Requested for: ______________________________ NJIT Phone Extension: _______________
Detailed Description of Reimbursement:
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DEPARTMENTAL APPROVALS:
(Must be a one-up Supervisor Signature)
Accounting Distribution: (all boxes MUST be completed)
CHART
INDEX
ACCOUNT
AMOUNT
Total
Amount Requested: _____________
Approver:
Department
Phone Extension
Approver Signature: __________________________________________
(Must be original, photocopies will NOT be accepted)
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DISBURSEMENT:
Pickup by: _____________________________ Date: ________________________
Issued by: _____________________________
Bursar Supervisor Authorization for Academic Studies: ____________________________
$ 0.00
$ 0.00