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Purchasing Card Missing Receipt Form


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UW – Madison Purchasing Card Program
Purchasing Card Missing Receipt Form
This form is to be used on rare occasions when vendor documentation is lost or unavailable. Frequent use of this form will be considered non-compliant with Purchasing Card Program Policies and Procedures.


Vendor Name (required):      

Vendor Phone Number:      

Vendor City & State:      

Date order placed (required):      

Order placed by:      




Quantity

Unit Price

Description

Total Cost

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

Order Total (required): $      



Reason for use of this form:

     

Cardholder Signature (required):

Print Name:      

Date:      

Site Manager Signature (required):

Print Name:      

Date:      






ACCOUNTING SERVICES

University of Wisconsin – Madison • 21 North Park Street, Suite 5301 • Madison, WI 53715



Phone: (608)-262-3300



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