CHARGE/PAYMENT INITIATION FORM

SAR CHARGE CODE

INITIATION FORM

Department: _________________________________________________________

Transaction Description (30 characters or less):

Purpose/Explanation: _________________________________________________ 

___________________________________________________________________ 

___________________________________________________________________ 

Frequency of Charges per Month: _________________________________________

Max. Amount per Transaction: ___________________________________________

FRS Information

0	1	---		---		---	6	9	C
Campus-Code			Account		Sub-Code		Entry-Code

Prepared By & Date Signature Department Head & Date

Office of the Bursar SAR Control Group Only

Date Received: ______________________ Effective: ______________________

Charge Code Assigned: ________________________________________

Short Description:

(up to 12 characters)

Campus Address: Accounting Department

1110 Lee Building

College Park, MD 20742

FAX # (301) 314-9098