ARKANSAS TECH UNIVERSITY P-CARD MISSING RECEIPT
Purchasing Department Tel: 479-968-0269
Russellville, AR 72801-2222 Fax: 479-968-0633
Date: _______________________
From: Cardholder Name: __________________________________________
Department: _______________________________________________
Cardholder Phone No: __________________________
Last 4 Digits of Card No: ______________
Merchant’s Name: ______________________ Transaction Date: ______________
Amount of Transaction: $ _________________
What was purchased: __________________________________________________
____________________________________________________________________
____________________________________________________________________
Briefly describe circumstances of missing receipt: ____________________________
____________________________________________________________________
____________________________________________________________________
Cardholder’s Signature: ________________________________________________
Note: Provide a copy of this report to your Immediate Supervisor.
REPEATED LOSS OF RECEIPTS MAY RESULT IN SUSPENSION OF P-CARD PRIVILEGES.
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