Fillable Replacement Receipt Form (Golden Gate University)

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Replacement Receipt Form (Golden Gate University)

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PCARD / OOP RECEIPT REPLACEMENT FORM
Updated May 4, 2010
Cardholder:
Amount of purchase:
Purchased online (no receipt offered)Receipt not issued at time of purchaseLost receipt
Reason original receipt was not provided (please check all that apply):
I affirm that the charge listed above is a valid charge to my Golden Gate University PCard or is a valid out-of-pocket
expense, and understand that as the cardholder, I am responsible for providing receipts for all purchases or transactions that
are $25.00 or above.
Date of purchase:
Description and reason for purchase (please give detailed information):
Was this an out-of-pocket expense to be reimbursed to you?
Vendor Name:
Please complete one form per charge.
Cardholder's signature
Date
Date
Approver's signature
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Replacement Receipt Form (Golden Gate University)

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Completed 24 July 2020

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