PAY TO: (Person to receive advance)
I hereby authorize the above to receive and/or use funds to make purchases not to exceed $25.00; certify
that budgeted funds are available in the account indicated above to cover such purchases and that such
purchases are appropriate to be charged to the account number indicated above.
CASH RECEIVED/DISBURSED BY
BUDGET MANAGER AUTHORIZED SIGNATURE
Index Fund Organization Account Program Activity
1. Make sure the amount authorized has sufficient funds and does not exceed $25
ake the form to Student Financial Services for reimbursement along with the
original receipts. KEEP COPIES OF THE RECEIPT FOR YOURSELF.
COPIES WILL NOT BE ACCEPTED IN REPLACE OF ORIGINAL RECEIPTS!
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