PROCUREMENT CARD RECEIPT EXCEPTION FORM (Please print or type information)
Instructions:
Use this form when a receipt was not provided after a transaction or when a receipt was lost. Please complete and return the form to your Card Coordinator.
Please Print or Type Information
1. Cardholder Name:
2. Agency:
Valencia College 3. Campus:
4. Work Number and/or Extension:
5. Budget Manager:
6. Department:
7. Transaction ID:
8. Transaction Date:
9. Posting Date:
10. Amount:
11. Merchant Name:
12. I certify that the referenced transaction is a valid purchase as outlined in the Pcard Policy Manual.
13. Date:
Signature:
List the items that were purchased and indicate the reason why the receipt is unavailable. (If the receipt arrives after the download, attach the receipt with this form and save both for audit reviews) 14.
. Form Version 4.2
updated 9/2011
Valencia College