Missing Credit Card Receipt Form
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1MISSING CREDIT CARD RECEIPT FORM
Cardholder/Approving Official must fill out form below:
(print out form for signature)
Statement Date:
Date of Purchase/Service:
Vendor Name
(one per
form):
Dollar Amount:
$
-
Steps taken to obtain duplicate copy:
Reason you were unable to obtain receipt/invoice:
Date:
Print Cardholder Name:
Cardholder Signature:
Print Approving Official Name:
Approving Official Signature (required) :
List each item separately, list tax as a line item.
Unit
Unit
Item Description
Quan
Price
Total
Item Description
Quan
Price
Total
Tax
Total
0.00
This form should be used occasionally. It is the Cardholder's responsibility to obtain a self-expanatory receipt/invoice from the vendor at the time of purchase.
9/6/13
Missing Credit Card Receipt Form
District 015
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Parent category: Business