Rocky Mountain College| Business Office Services
Missing Receipt Form
Type: College Purchasing Card Out-of-Pocket Expense: Expense Report
Date of Purchase:
Location of Purchase (Include vendor name and address):
Itemize the Purchase:
Items purchased, Description of item(s), (attach additional sheet(s) if necessary
Amount spent:
____________________________________
Business Purpose for Purchase:
Reason receipt is missing and why you cannot obtain a copy:
What attempts have been made to request a duplicate receipt from the merchant? (Please include names, dates, phone
numbers or emails used in requesting documentation from the merchant.)
___________
I understand that a Missing Receipt Form may not be completed on a routine basis and that overuse may revoke the
privilege of providing a Missing Receipt Form in lieu of a receipt. I certify that the amount shown is the amount
actually paid, that I have not and will not submit a duplicate claim, and that I have not and will not seek a claim for
these expenses from any other source.
Employee Name (Last/First/Middle) Please Print
Employee’s Signature (required)
Approving VP Signature (required) Date
