Contact Name: UM Dept:

Email: Phone:

Amount of Advance:

Total of Attached Receipts:

*

UM Foundation Fund #

Advance Date: MM/DD/YY

Advance Check #:

* The obligation created by the original Withdrawal Request for Advance will not be released until the full

amount in receipts and/or funds are returned to the Foundation office. If the enclosed funds do not equal the

required amount please attach a separate explanation. If the total receipt amount exceeds the original

advance amount, submit a UMF Withdrawal Request for the balance due you.

Advance Clearing Form (updated 7/18/2011)

PURPOSE: This form is to be used to clear an advance made against a Foundation fund.

INSTRUCTIONS: This form is to be completed by the campus department contact, printed, and signed.

Attach original receipts to the completed form and submit to Lisa Svingen, UM Foundation Accounting

Specialist, Brantly Hall. For questions, contact Lisa at SvingenLM@mso.umt.edu or 243-4296.

Section A: ADVANCE DETAILS

Please PRINT Name Date

I affirm that the submitted payment or purchase described above matches the description on the orginial

check request and is a proper charge to the indicated UM Foundation fund according to the terms of the

corresponding account agreement.

AUTHORIZED SIGNATURE

Section B: SIGNATURES

0.00

Funds to be returned

or (refunded):

Business Purpose

of Advance: