Fillable Substitute-receipt-form-p-card VISA CARDHOLDER

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Substitute-receipt-form-p-card VISA CARDHOLDER

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U.S.A. forms for University of Wyoming

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Revised January 19, 2012
UNIVERSITY OF WYOMING CARDHOLDER
SUBSTITUTE RECEIPT / DISPUTE FORM
Please use a separate form for each transaction.
ACCOUNT INFORMATION
Account Number
(last six digits only):
XXXX-XXXX-XX -
Cardholder Name:
Work telephone number:
Select one:
- This is a substitute receipt. Include reason for lack of documentation in the Details section. BOTH
THE DEPARTMENT HEAD AND CARDHOLDER MUST SIGN BELOW before forwarding this document, with the
transaction log, to the Accounts Payable Office in Old Main.
- This is a disputed transaction. Department head signature is not required. Cardholder should begin
resolution of the dispute with the vendor, and is to notify Procurement Services of the dispute (fax 766-2800). If this
dispute cannot be resolved within 45 days of the transaction date, Procurement Services will then assist to resolve
the dispute.
PROVIDE NECESSARY DETAILS:
INCLUDE VENDOR NAME, DATE, AMOUNT OF TRANSACTION, AND EXPLANATION
Please sign and date after completing and printing the form
CARDHOLDER SIGNATURE _____________________________________ DATE ______________________
If this is a Substitute Receipt, Department Head signature is required.
DEPT. HEAD SIGNATURE ________________________________________ DATE ______________________
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Substitute-receipt-form-p-card VISA CARDHOLDER

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Completed 8 February 2020

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