BANK RECONCILIATION FORM

YOUR COMPANY
For the Month Ended 01/00/00
Statement Date
Ending Balance

12/30/99
$
-

Less: Outstanding Checks

Add: Outstanding Deposits
Other Adjustments

Adjusted Balance

Book Balance for Cash Account

Variance

Outstanding Checks
Date
Check #
Amount

BALANCED

--

Outstanding Deposits
Date
Amount

--

Adjustments
Date
Amount

### -