Missing Receipt Form - Sweet Briar College

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S
B
WEET
RIAR
C
OLLEGE
Business Office
Missing Receipt Form
This form is to be used for lost or missing receipts of $25.00 or more for reimbursement. For College Purchasing Card charges, this
form should be used for EACH missing receipt, regardless of dollar amount.
Merchant Name:
Merchant Address:
Date of Purchase:
Description (list of items purchased):
Business Purpose:
Purchase Amount:
Explanation for why receipt is not available:
By signing my name below, I,
certify the following:
(Type or Clearly Print Name)
1) This purchase was made for OFFICIAL college business.
2) I am aware the College requires original receipts for all purchases and by completing this missing
receipt form, I acknowledge that I may be in violation of college policy, depending upon the
circumstances.
3) If this purchase was made on a College Purchasing Card, the card may be suspended for not
providing original receipts.
SIGNATURE OF PURCHASER (employee who made purchase should sign, not cardholder)
DATE
SIGNATURE OF DEPT HEAD/APPROVER
DATE
Please attach this form to your reimbursement request or purchasing card statement and forward to Accounts Payable, Prothro
Hall, 3rd floor
SBC BUSOFC/AP_MR_02_09.pdf
Print Form

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