Petty Cash Reimbursements


  • Use only for purchases totaling less than $150.00
  • Within the box, or on attached page, securely mount original receipts with tape. Do not overlap or cover other parts of form.
  • Complete bottom part of form providing FULL ACCOUNTING UNIT data and the four-letter OWNER CODE for your department.
  • Completed form must be APPROVED BY person with the budget signature authority or by person authorized to sign for purchases on budget's associated Low Value Purchase Authorization.
  • Internal controls, such as a separation of duties, should be observed. Therefore, APPROVED BY person may not be same person who receives payment.
  • Retain copy of the form for department file.

Download the Petty Cash Reimbursement Form