Appendix-2
Oakland University
Petty Cash Request / Repayment Agreement

Petty Cash Request
	
Amount of request:	$ 

Reason petty cash is needed:

Petty Cash Repayment Agreement

I,   ___________________________, acknowledge that I am responsible for the 
     (Custodian’s full name)
sum of _______________which has been advanced to me to set up a petty cash fund 
                  (insert amount requested)
for reimbursements for minor items purchased by my department in accordance with OU policies.   I agree to submit in full any balance due from the petty cash advance to the Cashier at the Oakland University Cashier Department upon demand.

If this amount, or any portion of it, remains unpaid after the request for repayment,  

___________________________, or in the absence of the custodian, 
     (Custodian’s full name)

___________________________, 
     (Custodian’s Supervisor’s full name)

hereby authorize Oakland University to deduct the outstanding amount from any compensation due.  This Agreement is entered into fully and freely without intimidation or fear of discharge for refusal to permit the deduction.

Signed ___________________________________   Department________________________
	 (Custodian)

Grizzly ID #________________________________ Date______________________________

Signed____________________________________ Department________________________
  	(Custodian’s Supervisor) 

Grizzly ID #________________________________ Date______________________________

Approved_________________________________ Date_______________________________
      	     (Accounting Office)

Submit original form to the Accounting Office, 121 VBH, call 248-370-2447 with questions.