Lost/missing Itemized Receipt Form printable pdf download

Lost/missing Itemized Receipt Form

CARD PROGRAM

LOST/MISSING ITEMIZED RECEIPT FORM

IMPORTANT-PLEASE COMPLETE THE FORM AND SAVE IT AS A “PRINT PDF”. IF NOT SAVED THIS WAY, THE

DOCUMENT WILL BE BLANK WHEN ATTACHED IN WORKS.

TO SAVE A DOCUMENT AS A PRINT PDF, ONCE COMPLETED SELECT “PRINT” AND THEN CHOOSE “SAVE AS PDF” AS

YOUR PRINTER. THEN SELECT SAVE AND SAVE IT TO YOUR COMPUTER. IT WILL THEN BE AVAILABLE FOR

ATTACHING IN WORKS WITH ALL OF YOUR DATA VISIBLE.

I, ____________________________________, have either misplaced or not received an itemized receipt for the

credit card transaction number CRD_______________totaling $_____________that was charged on my Union

College credit card.

This affidavit is submitted in lieu of an original itemized receipt and attests that:

 No original itemized receipt for this expense is available after making attempts to acquire one.

 The expense was incurred on behalf of Union College business.

 The item and amount of the expense are accurate.

 No reimbursement of this expense has been or will be sought or accepted from any other source.

 I understand that the Card Program office may contact the Vendor to attempt to obtain an itemized

receipt on my behalf.

Vendor Name

_____________________________

Amount

$ ____________________________

Date of Purchase

_____________________________

Item Description

_________________________________________

Use ID # as Signature

______________________

Date___________________

***ATTACH THIS AFFIDAVIT TO YOUR CREDIT CARD TRANSACTION IN WORKS AS A REPLACEMENT

“PRINT”

PDF

SCANNED RECEIPT. REMEMBER TO SAVE THIS DOCUMENT AS A

Lost/missing Itemized Receipt Form