University of West Georgia
P-Card Account Summary Form
Instructions:
1. Summarize charges by chart of account number. Please complete a separate summary form for each chart of
account number utilized with the appropriate receipts attached.
2. Obtain appropriate signatures. Please note that the cardholder and approver cannot be the same individual.
3. Forward original purchasing card statement, original receipts, account summary and transaction log to the P-Card
Administrator by the deadline date.
By signing below I certify that I have made all of the listed transactions on behalf of the Agency and that they comply
with the established procedures for using the purchasing card.
Cardholder Signature: Date:
By signing below I certify that I have reviewed all of the charges, invoices/receipts, and charging information for the
attached purchases. All charges and documentation comply with State and Agency purchasing regulations and all
charging information is complete and correct.
Approval Signature: Date:
Authorized Approver (Required)
Date:
Dean or Vice President (if applicable)
Date:
Research & Sponsored Operations or Tech Fees (if applicable)
Amount
Account Fund Dept. ID Program Class Project ID
Statement Date:
Last 8 of card #:
Chart of Account:
Total Charges
Cardholder Name:
Department Name:
