Form# SOMEBANK-0011
Checks and other items are received for deposit subject to the provisions
of the uniform commercial code or applicable collection agreement.

Checking Account Deposit

Customer Number

Name (Please print) Date Deposits may not be available for immediate withdrawal Sign here for cash received (if required)

SOMEBank

Total deposit

123456789

List checks singly or attach list

Dollars

Cents

Currency

Coin

Checks

Total from
other side

Total

Less Cash Received

10

Currency Count - For Financial Institution Use Only
	100
	50
	20
	10
	5
	2
	1
Total		$

Checks List singly

Dollars

Cents

Total
must be entered on front side