PurchasingCard
MissingReceiptForm
PurchaserandVendorInformation:
Purchaser'sName:
Purchaser'sDepartment:
PurchaseDate:
VendorName:
Methodof Purchase: InStore Phone Internet Other:
AmountofPurchase:
DetailedDescriptionofEachItemPurchased:
Description Quantity UnitPrice TotalCost
Total
TheCityisexempt
fromsalestaxinmostinstances
Explanation:
ReasonforMissingReceipts:
OriginalReceiptLost NoReceiptwasGiven Other:
AdditionalExplanationorNotes:
Signatures:
Cardholder/Purchaser'sSignature: Date:
SupervisorSignature: Date:
Thisformistobecompletedasdocumentationonly
iftheactualitemizedreceiptisnotattainableforatransactionmade
withthePCard.Useofthisforminlieuofanactualreceiptshouldbearareexception,nottherule.Usingtheformmore
thantwiceinanyfiscalyearmaybegroundsfordiscontinuinga
Cardholder'suseofthePCardorotherdisciplinaryaction.
Theformmustbefilledoutcompletely,signedbytheCardholderandbytheCardholder'sSupervisororCardManager.
IattestthattheabovepurchasewasmadeforthebenefitoftheCityofMeriden/PublicSchoolswhileconductingofficial
Citybusiness.IcertifythatIhaveattemptedtoobtainanoriginalreceiptfromthevendor.
KeepthisformwithyourotherPurchasingCarddocumentationinlieuoforiginalreceipt.
Note:Every
effortshouldbemadetoobtainanoriginalreceiptfromthevendor.
click to sign
signature
click to edit
click to sign
signature
click to edit
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