GEOS307 Broken Hill/ Olary field trip

Date: …………………………………

Receipt Form to University Cashier

Payment
Type Code	Amount	11 digit Account Code	Name of Payer	Receipt Number	Type of Income	Payment Mode (Note 1)	
E05	$485.00	92092058531			ACCOM FOR COMPULSORY EXCURSION		
TOTAL	$485.00	92092058531					
Note 1.  Enter a 1 for cheques, 2 for cash, 3 for credit card

Handed to cashier by:____________________________________________________________________
                                                                        Please print first and last name

Contact phone number:_________________________________________________