Fillable Missing Receipt Form (University of West Florida)

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Missing Receipt Form (University of West Florida)

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UWF Financial Services, October 2015
University of West Florida
MISSING RECEIPT FORM
This form is to be used as documentation to replace a missing receipt ONLY after a reasonable effort is made
to secure a duplicate receipt and should be submitted with the Travel Expense Report. This is a request for
an exception to UWF procedure, which may be denied. The form requires Traveler and Department Head
signatures. Please note that repeated failure to secure receipts for business expenses may result in denial of
reimbursement.
Payee Name:
UWF ID#:
Merchant Name:
Date of Transaction:
Description of Item(s)
Cost of Item(s)
1.
2.
3.
4.
Total Purchased:
State the reason for missing receipt and describe attempts made to request a duplicate receipt from the merchant
(include
names, dates, phone numbers and attach emails used in requesting documentation)
:
I validate that the above listed Item(s) were purchased by me and that a reasonable attempt was made to obtain an
itemized receipt from the merchant.
_____________________________________________ _____________________________________________
Traveler Signature Date Traveler Printed Name Date
_____________________________________________ ____________________________________________
Supervisor Approval Date Supervisor Printed Name Date
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Completed 18 July 2020

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