Fillable Tcardmissingreceipt (Arkansas Tech University)

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Tcardmissingreceipt (Arkansas Tech University)

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ARKANSAS TECH UNIVERSITY 7-CARD MISSING RECEIPT
Procurement and 7UDYHO6HUYLFHV Tel: 479-356-6209
Russellville, AR 72801-2222 travel @atu.edu
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: ________________________________________________
This form should be used on a limited basis and is not a substitute for proper documentation.
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Completed 16 July 2020

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