HTML Preview Purchase Cash Receipt page number 1.
Billing Date _________ Verifier Initial Date __________
Approver Initial ________ Date __________
Office Use Only
Purchasing Card Receipt Form
Provide an itemized and signed receipt.
Do not tape over the words on your receipt.
Do not write over print on receipt.
Receipts smaller than an 8 ½ x 11 sheet of paper
must be taped to an 8 ½ x 11 sheet of paper.
Do not use staples.
The following information is required for auditing purposes:
Cardholder: ____________________________________
Funding Source:
De
p
t. ID Fun
d
Progra
m
Source Budget
Ref.
P
r
ojec
t
# Flex Code UFID CRIS Charge
Amount
Total:
Faculty Name: __________________________________
Vendor: _______________________________________
Vehicle or Tag #: ___________ Boat #: ______________
Please list the items purchased (most expensive first):
_________________________________________________
_________________________________________________
_________________________________________________
How does this purchase directly benefit the funding source? (Please be detailed – use the back of the page or
attach a separate justification if required):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Cardholder Signature: ____________________________ Date Received: ___________________
Account-holder/Designee Signature: _____________________________
Office Use Only:
Account Code ________________
TA# _________________________
ER# _________________________
RA# _________________________
Last Modified:
3/31/2015