Chapter Bank Reconciliation Form

Helpful Tips:

It can be helpful and quicker to print out the Bank Reconciliation form. If the computer "times out", while filling out the form, you will need to start over. Once printed, pencil in your chapter's information before performing the following steps in this order:

1. Obtain or create electronic copies of all 3 bank statements for the quarter and save them to your computer (must be in pdf. format).

2. Complete and save the Cash Disbursements Form to your computer (if the chapter paid out any money).

3. Complete and save the Cash Receipts Form to your computer (if the chapter received any money, including interest).

4. Complete this Bank Reconciliation Form and upload the previously saved bank statements, cash disbursements form, and cash receipts form, then "submit." You will receive an immediate confirmation number; it will then take a few days to review and process your submission and update your Good Standing grid.

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Chapter Information

Chapter Name : *
please spell out the full chapter name
Chapter Financial Code : *
four digit number that begins with 4_ _ _
Bank Name: *
Account Type: *
Fiscal Year (July 1, 2016 - June 30, 2017):
Quarter: *
Month(s): *
Prepared By: *
Email Address: *

Bank Account

(Format for dollar amounts should be 1200.00)

Ending balance shown on the bank statement (For the individual month OR the last month of the quarter): *
Date of Statement : *

Add deposits made, but NOT shown on current statement

Outstanding Deposit Total:

Subtract checks written, but NOT shown on current statement

Outstanding Checks Total:
Adjusted bank balance:
Ending balance + Outstanding Deposits – Outstanding Checks = Adjusted Bank Balance).

Supporting Documents

Please check one:

Account Activity - Chapter DID have Cash Receipts and/or Cash Disbursements for this reporting period (attached below):
No Account Activity - No Cash Receipts or Cash Disbursements to report:

The Cash Receipts and Cash Disbursement Forms can be attached to this form one of two ways. Attach one completed form for each month of the quarter OR attach one completed form that includes information for all three months of the quarter.

Attach Cash Disbursements Form (Month 1):
Attach Cash Receipts Form (Month 1):
Attach Cash Disbursements Form (Month 2):
Attach Cash Receipts Form (Month 2):
Attach Cash Disbursements Form (Month 3):
Attach Cash Receipts Form (Month 3):
Attach Cash Disbursements Form (All 3 months):
Attach Cash Receipts Form (All 3 months):

Bank Statements are mandatory:

Attach Bank Statement (Month 1):
Attach Bank Statement (Month 2):
Attach Bank Statement (Month 3):
Attach Bank Statements (All 3 months):

Miscellaneous Attachments (i.e. PayPal statements, Quicken reports, etc.)

Miscellaneous Attachment:
Miscellaneous Attachment:
Miscellaneous Attachment:

Further Comments:

Your Name: *
Your Email Address: *




revised 10/2016

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