Fillable Missing Receipt Form printable pdf download

Missing Receipt Form

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University of Central Oklahoma

PCard – Missing Receipt Form

Cardholder Name _________________ Department __________________

Cardholder Phone _________________ Date of this report _____________

Card Number (last 4 digits) __________

Merchant _______________________ Date of Purchase ______________

What Purchased __________________ Cost ________________________

Describe circumstances of missing receipt:

____________________________________________________________

Purpose of Purchase:

____________________________________________________________

Cardholder Signature ___________________________________________

Please retain this form in your departmental files for later PCard review.

NOTE: REPEATED LOSS OF RECEIPTS MAY BE GROUNDS FOR

DISCONTINUING A CARDHOLDER’S PCARD USE OR OTHER DISCIPLINARY

ACTION.

Last updated on 11/22/2013.

Missing Receipt Form

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