UNIVERSITY OF WISCONSIN – OSHKOSH

CASH ADVANCE REQUEST Submit in duplicate to Office of

The Controller. One copy will be

returned to the requestor.

Date :__________________ Type of Advance: ____Temporary ____ Permanent

Name of Department: _________________________________

Department Code: ____________________________________

Purpose/Justification: _______________________________________

__________________________________________________________

AMOUNT REQUESTED: ______________

Date needed: ______________ Date to be returned: _______________

Individual handling cash advance: ______________________________

Signature of responsible individual: _____________________________

For Accounting Office use only

___ Approved ___ Not Approved _______________________________________

Controller

______________________________________________________________________

Comment

Date check issued ___________ Check # ____________ Amount _______________

Date advance revised ________________ Date advance returned ______________