Request for Chargeback

CSUSB General Accounting Office

This form is for internal CSUSB staff use. If you have any questions, please contact Alex Waller (alanier) in the Accounting Office at 537-3215. Thank you.

All Fields Are Required

Requested by:


This charge back must credit the account bearing the expense for the services or materials provided. This chargeback cannot credit a Trust account for services or materials provided at the expense of the operating fund.


PS Credit Chartfield:

PS Debit Chartfield:

To send this information, please press the SUBMIT FORM button below. Once you have done this, information is sent immediately. If you discover an error, please contact Alex Waller in Accounting at extension 537-3215

California State University, San Bernardino
5500 University Parkway, San Bernardino, CA. 92407
Phone: 537-3215, Email: Alex Waller
Last Updated: