

____________________________ ____________________________ ____________________________
STATE OF LOUISIANA STATE LIABLITY TRAVEL CARD/CBA PROGRAM
CARDHOLDERSTATELIABILITYTRAVELCARD(T‐CARD)LOG–FORBILLINGCYCLE__
_
CARDHOLDERNAME:____ ________________________________
CARDHOLDERACCOUNT NUMBER(LASTFOURDIGITS):____________ _________________________
NO DATE VENDOR NAME DESCRIPTION QTY AMOUNT RECEIPT
DATE
OTHER INFORMATION
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
PAGE TOTAL:
TheT‐Card/CBALogis tobeused tohelp reconcilepurchases/services made duringthebillingcyclebymatching thepapermemo statement received fromthebank
totheT‐Card log and the documentation obtainedfrom thevendors on purchases/services.The documentation must bereviewedand certifiedbythe Cardholder as
receivedorreportedasadisputed item. Each charge/creditshouldbeverified.The Cardholdershouldthensignanddatethe T‐Card/CBAlog andforwardto his/her
Supervisor. The Cardholder’s Supervisor ordelegatedreviewer must reviewallT‐Card transactions,documentation and papermemostatement.Todocumentthis
reviewand approval,the Supervisor/Revieweristosignanddatethe T‐Card/CBA Log.After approval,the original documentation,T‐Card/CBA Log, andthepaper
memo statement areforwarded to theBusinessOffice. TheBusiness Officeisresponsibleforcostdistribution,payment,and record retention.
___________________________________________ ___________________________________________ ___________________________________________
CardholderSignature Supervisor/ReviewerSignature STCC BOReviewerSignature
Date Date Date