Mandatory-Credit-Debit-Deposit-Form-revisedMay-2010

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					                                               Credit/Debit Deposit Memo
                                              Department:
                                                    Date:          January 1, 2012



     Debit/Credit Card Receipts:
                                   Merchant I.D.
                              Transaction Date
                               Settlement Date
                                                                                           Visa
     Description of Product or Service Sold                                          Mastercard
                                                                                         Interac
                                                                              American Express

                                                                              Total Receipts: **                   0.00


     Revenue Distribution:
                                         Fund*       Org*   Account*     Program       Activity    (* denotes required field)
                      FOAPAL1:                                                                                      0.00
                      FOAPAL2:                                                                                      0.00
                      FOAPAL3:                                                                                      0.00
                      FOAPAL4:                                                                                      0.00
                      FOAPAL5:                                                                                      0.00
                      FOAPAL6:                                                                                      0.00
                      FOAPAL7:                                                                                      0.00
                      FOAPAL8:                                                                                      0.00
                      FOAPAL9:                                                                                      0.00
                      FOAPAL10:                                                                                     0.00
                      GST               100000               225000                                                 0.00
                      PST               100000               225002                                                 0.00
                      HST               100000               225008                                                 0.00

                                                            Total Revenue Distribution: **                         0.00

                                                 Total Receipts less Total Distribution: **                        0.00
**    Differences between Total Receipts and Total Revenue Distribution will be charged to the department's
     budget via account code 716702.



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