HTML Preview Itemized Restaurant Receipt page number 1.
FORM%#3%
MISSING%ITEMIZED%REST A U R A N T % RECEIPT%
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Cardholder:!_________________________!
Statement!Closing!Date:!_______________!
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**Before!submitting!this!form,!try!to!contact!the!vendor!for!a!copy!of!the!
itemized!receipt.!!If!you!are!u n ab le!to !g et!a!c o py !from!the!vendor!then!enclose!
this!form!in!your!pAcard!log.!
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VENDOR%
ITEM%DESCRIP TION%
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AMOUNT%
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______________________________! ! ________________!
!!!!!!!!!!!!Cardholder!Signature! ! ! ! Date!
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______________________________! ! _________________!
! Dean/Supervisor!Signature! ! ! Date!