PURCHASING CARD PROGRAM MISSING DOCUMENT AFFIDAVIT This form should be completed for any Purchasing Card transaction that does NOT have documentation from the merchant.
Cardholder Name: Telephone Number: Phone: Department: Vendor/Merchant Name: Transaction Date (month/day/year): $ Transaction Amount (Total Cost): Description/Quantity/Cost Per Item/Total Cost: (Add an additional sheet if necessary): Reason Original Documentation is Not Available Cardholder Certification Signature: I attest the information provided is true and an accurate description of the details of the purchase.
I confirm that every attempt to obtain a duplicate receipt by contacting the vendor has been made, but have been unable to do so and also hereby certify the ...
Allowed
Microsoft Office Word (.doc, .dot) - application/msword
3300-012 Purchasing Card Missing Document Affidavit Form Update 7-31-12.doc
DELGADO FORMS 
