Petty Cash Receipts Summary Form

Use this form to request petty cash reimbursement. For each expense, an individual must submit original receipts to the fund custodian, and sign off on the Petty Cash Receipts Summary Form upon receipt of reimbursement. The custodian must manage the reimbursement process.

The Receipts Summary Form should provide the following information:

  • Documentation of the date of purchase
  • Name of the person reimbursed
  • Description of the item purchased, including a valid business reason
  • For business meals inside the office, document the purpose of the meeting and list those in attendance if 10 or fewer people or the number of attendees if a group is larger than 10
  • For local transportation, including origin, destination, and business purpose
  • Dollar amount (not to exceed $80)
  • Original receipt
  • Signature of the person who received payment
  • Signature of the custodian or senior DAF who approved the reimbursement