University of Wisconsin - La Crosse
Deposit Remittance Form
Print TWO Copies and Send ONE to Cashier's Office, 121 Graff Main Hall

Submitted By

Date to Cashiers

Unit / Department

Phone #

Send Receipt To

Room & Bldg.


NON-TAXABLE REVENUE
Deposit coding questions should be directed to Kathy Hanratty, Business Services at 5-8552

Dept ID #
(6 digits)

Account #
(4 digits)
Description
(Required)
Amount

EXPENDITURE REIMBURSEMENTS
(Send reimbursement deposits to Kathy Hanratty at 125 Graff Main Hall & submit all relevant backup)

Dept
ID #
Account # Voucher # Description
(Required)
Amount

Cashiers Use Only
.
.
.
.
Checks  $ 
Currency  $
Coin  $
   
Total Amount Enclosed  $