Property of AM Business Consultants, LLC
PETTY CASH RECONCILIATION FORM
1
General Information
Company/Department
Custodian Name
Reconciliation Date
Period Covered
Approved Petty Cash ($)
Custodian Title
2
Request Type
Replenish Expenditures
Establish / Increase Petty Cash
Current Amount ($)
Requested New Amount ($)
Increase Amount ($)
Justification
3
Cash on Hand Count
Bills
Denom.
Qty
Amount
$100
$0.00
$50
$0.00
$20
$0.00
$10
$0.00
$5
$0.00
$1
$0.00
Subtotal
$0.00
Coins
Denom.
Qty
Amount
$1.00
$0.00
$0.50
$0.00
$0.25
$0.00
$0.10
$0.00
$0.05
$0.00
$0.01
$0.00
Subtotal
$0.00
TOTAL CASH ON HAND:
$0.00
4
Expenditures / Vouchers
Date
Voucher #
Description / Vendor
Category
Amount
Select
Office Supplies
Postage
Travel
Meal
Repairs (Tools)
Gas
Software
Subscription
Telephone
Other
✕
Select
Office Supplies
Postage
Travel
Meal
Repairs (Tools)
Gas
Software
Subscription
Telephone
Other
✕
Select
Office Supplies
Postage
Travel
Meal
Repairs (Tools)
Gas
Software
Subscription
Telephone
Other
✕
TOTAL EXPENDITURES:
$0.00
+ Add Row
5
Reconciliation Summary
Cash on Hand
$0.00
Total Expenditures (Vouchers)
$0.00
= Total Accounted For
$0.00
Approved Petty Cash Amount
$0.00
Variance (Over/Short)
$0.00
Amount to Replenish
$0.00
Variance Explanation (if any):
6
Signatures & Approvals
Prepared By (Custodian)
Date:
Approved By (Finance/Manager)
Date:
Reset
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