Request Revenue Refund


Sometimes revenue must be refunded to an individual or organization after it has been deposited.

George Mason University has developed a Revenue Refund form to request checks for this purpose. This form should be used for all Revenue Refund requests.

Complete Revenue Refund form using the following instructions:

Optional Tracking Number RR ________

This is an optional number that may be assigned by the person completing the form. If a number is entered, it will appear in the detail transaction report in the COMM REF column. Any numbering system may be used.

Invoice Number (internal use only)

This space is for Accounts Payable or Student Accounts to assign an invoice number to the transaction.

Make Check Payable To

Enter the name and address of the refund recipient. If the FIN or G number is known, entering it in this section will expedite the payment process. Complete a separate form for each payee; multiple payees may not be combined on a single revenue refund form.

Date Submitted and Date Required

Enter the date submitted on all Revenue Refund forms. If there is a deadline for receipt of the check, enter that date here; otherwise, this line may be left blank. Revenue Refunds are normally processed within 10 business days. Email the completed form to and retain the original.

Requesting Department/Organization

Enter the requesting department name, and the name, mail stop number, and telephone number of the person Accounts Payable should contact if there are any questions about the revenue refund request.

Fund/org Number, Account Code, Amount

Revenue refunds must be processed as offsets to the fund/org and revenue account codes originally credited. The fund/org number(s) and account code(s) entered here must match those that were credited when the original deposit was recorded. Refer to the copy of the Cash Receipt, the Detail Transaction Report, or Banner Self Service Budget Status report to obtain this information.


Enter a brief reason for the request for a revenue refund. If there is a particular University policy that authorizes this refund, enter the name of the policy here.


Enter the amount of the revenue refund request.

Supporting Documentation

Revenue refund requests must include one of the following as supporting documentation:

      • A copy of the original, validated Cash Receipt form, or
      • A copy of an accounting report confirming the original deposit to the fund/org entered on the request. A printout from Self Service or E-Print will suffice.
      • Other documentation, as applicable. Please explain in the space provided on the form. First time payees who are not employees must complete and sign a W-9 form. Fax copies are acceptable. Attach this form to the completed Revenue Refund.

Signature Requirements

Revenue refund requests must be signed by the person completing the form and an approving official for the fund/org being charged. Approving officials must have a signature card on file in Accounts Payable.

Submitting Revenue Refund forms

Completed forms with original signatures should be emailed to Accounts Payable at Faxed requests will not be processed. A copy of the form should be retained for department records.

For Questions: