Missing Itemized Receipt printable pdf download

Missing Itemized Receipt

MISSING ITEMIZED RECEIPT

Restaurant Name:

TAPE CREDIT/PAY SLIP BELOW

____________________________________

City/St: _____________________________

Date: ______________Time: ___________

Meal Purchased:

Price:

Appetizer: (if applicable)

______________________ $___________

Entrée:

______________________ $___________

Dessert: (if applicable)

______________________ $___________

Drink: ________________ $___________

Sub Total:

$___________

Tax _______%:

$___________

Check Total:

$___________

______ No alcohol reimbursement included.

Unable to provide itemized receipt due to

_____ Restaurant not provide

_____ Lost / Misplaced

_____ Hotel Room Service / In House

_____ Other ____________________________

__________________________________

Accept this statement in lieu of itemized receipt

________________________________________

(Signature)

________________________________________

(Approved: Agency/Department Representative)

Date:_______________ Day: _____________________________ Meal:________________________

Missing Itemized Receipt