CHECK ONE:

☐ Corporate Credit Card

Reimbursement

Travel

Vendor Name:

Amount:

Date PurchaseG:

Items Purchased:

Purpose of Purchase:

Please explain the circumstances resulting in the missing receipt:

Please explain the action taken to obtain a duplicate receipt from the vendor:

I certify and attest that the above statements are true and I have incurred the described expenses. I further certify that these expenses were for official University purposes. I have also read and understand the University's policy requiring original receipts corporate credit card reporting and for reimbursement requests.