NAME OF APPLICANT
(Print or type – must be legible)
OREGON DEPARTMENT OF AGRICULTURE
APPLICATION FOR CASH ADVANCE
For Authorized Travel and Subsistence
I hereby request a cash advance for travel and subsistence during the month of
___________________, 20____, in the amount of $____________________.
This application is made in accordance with the provisions of ORS 292.280 to 292.288, inclusive and
Chapter 244, 1971 Laws which states: “The State shall have a prior claim against and a right to withhold any
and all funds payable, or to become payable, by the State to any officer or employee up to the amount of
Signature of Applicant
APPROVED-Signature of Director or Asst Director
The following applies: Must check one.
Employee is ineligible for a corporate travel charge card.
City State Zip Code
____ Newly hired employee who must travel prior to card being
Request disposition of check as follows:
Send to my address.
One time travel for employee who does not travel on a regular
basis. Regular basis is defined as more than twice a year.
____ Seasonal or part-time employee, etc, not eligible for credit card.
____ Other. Must complete & attach Exception Request Form1128A
When do you need your advance? Date____________________
FOR ADMINISTRATIVE SERVICES DIVISION USE