Procurement Card Missing/Lost Receipt Form
When a receipt is lost or otherwise unavailable and all measures to obtain a copy have been exhausted,
this Missing Receipt form should be completed, signed by the card holder and the card holder’s
supervisor, and attached to the credit card statement. This form should be retained by the department
accountant with all other pcard receipts and documentation.
I am missing a receipt for:
Description of Transaction
Vendor: Transaction Date: Amount: $
Receipt was (Check One)
Lost Never Received Other
Business Purpose of Transaction:
I understand that a Missing Receipt form should be used on rare occasions and may not be used on a
routine basis. I further understand that excessive use of a Missing Receipt form may revoke the privilege
of providing a form in lieu of a receipt.
Employee Signature Supervisor Signature
Employee Name Printed Supervisor Name Printed
Date Date
** Procurement Card Missing/Lost Receipt Form for campus credit card purchases only**
click to sign
signature
click to edit
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click to sign
signature
click to edit
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