UGA Charge to Account Form Instructions Use one form per account and per term. Attach additional students on a separate form. The department information section needs to be completely filled out and include who to contact with questions. The account number section must have an account number with the 77400 student tuition and fees object code already setup by the Accounting Department. For questions concerning this form or the UGA Charge to Account process please contact: Jennifer Mathews Shannon Lay Deidra Jones Student Accounts Jenni24@uga.edu slay@uga.edu dherndon@uga.edu (706) 542-2965 Clear Form Print form Student Accounts Charge to UGA Account Date Prepared Department Information Contact Person’s EMail: Contact Person’s Name: Contact Person’s Phone Number: Contact Person’s Department Name: Term: Account Information Use one account per form. Student fees object code must already be established by the Accounting Department. Account Name: Account Number: 77400 Object Code: Student Name ID Number Amount Total Hours $0.00 Attach additional students on a seperate sheet. If a fee can not be paid please indicate below: For Student Account Office Use Only: Request Processed October, 2003 http://www.busfin.uga.edu/forms/STA_charge_account.pdf JV Information Mailed