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  2. ASB

 ABCDEFGHIJK
1           
2            
3 REVENUE REFUND AUTHORIZATION FORM     
4            
5            
6            
7            
8            
9 PAYEE NAME:     AMOUNT:  $   
10   (PLEASE PRINT or TYPE)        
11       STUDENT     
12 STUDENT NAME:    NUMBER:     
13   (PLEASE PRINT or TYPE)        
14 ACCOUNT CODE         
15 (BUDGET)          
16            
17 ADDRESS      PHONE:      
18            
19 CITY   STATE      ZIP  
20            
21 REASON FOR REFUND         
22            
23            
24            
25 ORIGINAL RECEIPT #    Cash or Check  
26            
27 POS-REFUND RECEIPT #        
28            
29 PREPARED BY:    DATE     
30            
31 AUTHORIZED BY:    DATE     
32            
33            
34  FOR ACCOUNTING USE ONLY       
35            
36  Verification in POS Date      Initials  
37            
38  Deposit Verification Date      Initials  
39            
40            
41            
42            
43            
44            
45 Rev. 10/07   Section 4.02     4.02a

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 ABCDEFGHIJKL
1           
2             
3 ASB REVENUE REFUND AUTHORIZATION FORM     
4             
5             
6             
7             
8             
9 PAYEE NAME:       AMOUNT:  $   
10   (PLEASE PRINT or TYPE)         
11        STUDENT     
12 STUDENT NAME:     NUMBER:     
13   (PLEASE PRINT or TYPE)         
14 ACCOUNT CODE          
15 (BUDGET)            
16             
17 ADDRESS        PHONE:      
18             
19 CITY    STATE     ZIP   
20             
21 REASON FOR REFUND          
22             
23             
24             
25 ORIGINAL RECEIPT #     Cash or Check   
26             
27 POS-REFUND RECEIPT #          
28             
29 AUTHORIZED BY:          
30             
31 ASB Treasurer    Activity Advisor     
32    Date:       Date:  
33             
34 Student Representative   Primary Advisor     
35    Date:       Date:  
36             
37             
38  FOR ACCOUNTING USE ONLY        
39             
40  Verification in POS Date     Initials   
41             
42  Deposit Verification Date     Initials   
43             
44             
45          Revised Oct. 2007 

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