Accounts Payable Forms	Accounts Payable Tel No (818) 677-3472 Fax No: (818) 677-4581 Mail Drop: 8202
	Petty Cash Reimbursement Request Total $50.00 or less, Excluding Tax

EMPLOYEE NAME:		DATE:	CSUN EXTENSION:
DEPARTMENT NAME:			REQUISITION NO:

I. DESCRIPTION:	AMOUNT:
	$
	$
	$
	$
	$
	$
	$

II. ACCOUNTING DISTRIBUTION:
ACCOUNT:	FUND:	DEPT ID:	PROGRAM:	CLASS:	PROJECT/GRANT:	AMOUNT:

III. INSTRUCTIONS:
1. WHEN TO USE THIS FORM:	THIS FORM IS TO BE USED TO REIMBURSE AN INDIVIDUAL WHO IS ASSOCIATED WITH CSUN, (FACULTY/STAFF), FOR PURCHASES THAT THE INDIVIDUAL HAS ALREADY MADE ON BEHALF OF THE UNIVERSITY. MILEAGE LESS THAN $10.00.
2. WHEN NOT TO USE THIS FORM:	DO NOT USE THIS FORM FOR REIMBURSEMENT OF: 1. TRAVEL & ENTERTAINMENT, 2. GIFTS OR ITEMS OF A PERSONAL NATURE
3. WHO MUST APPROVE:	THE "AUTHORIZED SIGNERr" MUST BE THE PERSON AUTHORIZED TO SIGN FOR THE FUND/DEPTID(S) LISTED ABOVE. HOWEVER, IF THE AUTHORIZED SIGNER IS THE PERSON TO BE REIMBURSED, THE NEXT HIGHER AUTHORITY MUST SIGN AS "AUTHORIZED SIGNER".
4. WHAT TO SEND:	THE ORIGINAL OF THIS FORM, ALONG WITH THE ORIGINAL INVOICE(S) TO BE REIMBURSED. THE ORIGINAL INVOICE(S) MUST: 1. BE IMPRINTED WITH THE VENDOR'S NAME 2. BE ITEMIZED 3. HAVE A DETAILED DESCRIPTION OF THE ITEM
5. WHERE TO SEND THIS FORM:	DELIVER IN PERSON TO: UNIVERSITY CASH SERVICES BAYRAMIAN HALL LOBBY/BH100R Between 8:30-4:00pm, Mon-Fri
PERSON RECEIVING CASH MUST BRING FACULTY OR STAFF IDENTIFICATION.

PERSON REQUESTING REIMBURSEMENT:
Employee Signature: ______________________________________	Date: ________________
Employee Title: ___________________________________

APPROVAL BY:
AUTHORIZED SIGNER: ______________________________________	Date: ________________
PRINT NAME:

FOR UNIVERSITY CASHERING USE ONLY:
CASH GIVEN TO: (Please Print)	SIGNATURE: ___________________________
AMOUNT PAID: $	Date: ________________