PRENUMBERED RECEIPT - COMMONWEALTH CAMPUSES

Form Instructions

1. Indicate the name of the individual making payment (and PSU-ID and address if applicable) in the space provided.
2. If payment involves a student account, indicate which semester/session is being covered.
3. Indicate the means of payment.
4. Date money is received.
5. Indicate the reason(s) for payment.
6. Indicate the total payment received.
7. Sign the form as the University representative receiving the money.