University of Maine Petty Cash Request

Presentation of Form

This form is presented in a large table with spaces to fill in the following information:

Payee Information:

  • Name
  • Campus Address
  • Phone
  • Employee ID


  • Amount of Item
  • Description and Purpose for items purchased:

Financial Information:

  • Account #
  • Amount to be charged
  • Unit (required)
  • Dept. ID (required)
  • Account (required)
  • Class
  • Fund (required)
  • Program
  • Project
  • Total Amount of Request:
  • Money Received by:
  • Date:

Department Approval:

  • Name:
  • Campus Address:
  • Phone:
  • Auth. Signature:
  • Date:

Additional Information Presented Page

The following text is also included on this form after Payee Information:

Reimbursement Guidelines

  • Receipts must be originals
  • Receipts must be no more than 90 days old
  • Receipts can total no more than $125
  • The University of Maine System is exempt from Maine sales tax. Employees will not be reimbursed for payment of sales tax.
  • The payee MUST sign this form.

The following text is found at the bottom of the page:

  • rev. 8/31/2006

For assistance with this form, please contact 207-581-5491 or

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