Fillable Pcard Lost Missing Reciept Form 2017 (California State University Channel Islands)

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Pcard Lost Missing Reciept Form 2017 (California State University Channel Islands)

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Division of Business and Financial Affairs
Procurement & Logistical Services
Lost/Itemized Receipt Form
Cardholder Name:
Qty: Unit Price:
Tax
Shipping
Total
Reasons original itemized receipt/receipt was not obtained for this order:
This affidavit is submitted in lieu of original receipt and attests:
No original reciept for this expense is available
The expense was incurred on behalf of the University business
No reimbursement of this expense has been or will be sought
or accepted from any other source.
I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT.
Date:
Approving Official Signature Date:
Print Name:
Employee Information
Vendor Name:
Purchase Date:
Extension Price
Description
Business Unit:
Cardholder Signature:
$ 0.00
CICMP
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Pcard Lost Missing Reciept Form 2017 (California State University Channel Islands)

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Completed 18 July 2020

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