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PETTY CASH RECEIPT
(Internal use only)
* Attach original paid receipts to back of petty cash receipt/ticket. If items purchased on receipt are not detailed, please list in fields above.
Rev. Date 4/17/2014
Received from: DALTON STATE COLLEGE BUSINESS SERVICES
Date: ______________________________
Purpose of Purchase: ___________________________________
For the following:
VENDOR NAME DESCRIPTION OF ITEMS PURCHASED AMOUNT TOTAL
TOTAL $
Department Name ______________________________________ __________________________________________
Signature of Purchaser
Account #/Speed Code #_________________________________ __________________________________________
Departmental Approval
Approved _____________________________________________ __________________________________________
Office of the Bursar CASH RECIPIENT (To be signed at cashier's window)
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