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STATE OF LOUISIANA STATE LIABLITY TRAVEL ‐CARD/CBA PROGRAM
CARDHOLDERSTATELIABILITYTRAVELCARD(T‐CARD)LOG–FORBILLINGCYCLE__
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CARDHOLDERNAME:____ ________________________________
CARDHOLDERACCOUNT NUMBER(LASTFOURDIGITS):____________ _________________________
NO DATE VENDOR NAME DESCRIPTION QTY AMOUNT RECEIPT
DATE
OTHER INFORMATION
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TheT‐Card/CBALogis tobeused tohelp reconcilepurchases/services made duringthebillingcyclebymatching thepapermemo statement received fromthebank
totheT‐Card log and the documentation obtainedfrom thevendors on purchases/services.The documentation must bereviewedand certifiedbythe Cardholder as
receivedorreportedasadisputed item. Each charge/creditshouldbeverified.The Cardholdershouldthensignanddatethe T‐Card/CBAlog andforwardto his/her
Supervisor. The Cardholder’s Supervisor ordelegatedreviewer must reviewallT‐Card transactions,documentation and papermemostatement.Todocumentthis
reviewand approval,the Supervisor/Revieweristosignanddatethe T‐Card/CBA Log.After approval,the original documentation,T‐Card/CBA Log, andthepaper
memo statement areforwarded to theBusinessOffice. TheBusiness Officeisresponsibleforcostdistribution,payment,and record retention.
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CardholderSignature Supervisor/ReviewerSignature STCC BOReviewerSignature
Date Date Date