1. General
  2. ASB

 ACFHIJKLMNOP
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 Check Credit Card 
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. 08/10    Section 4.02       4.02a 

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 ACFGHIJKLMNOP
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 Check Credit Card  
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             Rev 08/10 

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