P-CARD
UNAUTHORIZED PURCHASE FORM
Today’s Date:
Cardholder’s Name:
P-Card Account #:
Supervisor/Budget Head’s Name:
Form Initiated By (Check one):
CARDHOLDER SUPERVISOR/BUDGET HEAD PROGRAM ADMINISTRATOR
Description/Amount/Date of Unauthorized Purchase:
Explanation for Unauthorized Purchase: Provide circumstances causing unauthorized purchase.
Add an additional sheet and/or supporting documentation, if necessary.
How Will Purchase Be Reimbursed to the College?
Check one:
CARDHOLDER WILL RETURN MERCHANDISE AND PERSONALLY PAY FOR ANY
APPLICABLE RESTOCKING OR RELATED FEES.
CARDHOLDER WILL PAY BY CHECK OR MONEY ORDER TO CONTROLLER’S OFFICE PRIOR SECOND PAYDAY AFTER UNAUTHORIZED PURCHASE WAS NOTED.
| ___________________________________________ _______________
|
Signature of Cardholder Date
___________________________________________ _______________
Signature of Approver Date
| ___________________________________________ _______________
|
Signature of Supervisor/Budget Head (if different than Approver) Date
Original to Program Administrator; Copies to Cardholder, Approver, and Supervisor/Budget Head
Form 3300/014 (8/18)
Back to top
