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General Receipt Template 1

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General Receipt Template 1
General Receipt Template 1
Receipt Template
St. Olaf College
Required when you do not have the required receipt/documentation from the merchant.
Repeated use of this form as substitute documentation may result in card revocation or failure to be reimbursed for expenses > $25.00.
Documentation from the merchant is required for every product purchased.
Transaction documentation may be:
• Receipt and transaction slip from the merchant;
• Packing slip from the delivery (if the packing slip is the only documentation, it must show either the cost of each item
or the total cost of the order);
• Invoice showing payment; or,
• Order form for dues, memberships, subscriptions, or similar items.
Transaction Information
Employee Name: ________________________________________ Merchant (Vendor) Name: ____________________
Department: ____________________________________________ Purchase Date: _____________________________
Description, Quantity, Cost of Each Item Purchased (attach additional sheet if necessary)
Must list names of all individuals present for meals, registration fees, etc.
Description Quantity Per Item Cost Total Cost
Total Cost:
Reason original documentation is not available:
Attach any additional information, correspondence, or justification about this transaction.
Alcohol: Yes ______ No ______ Alcohol is only allowed as specified in the travel policy and requires
approval or must be reimbursed to the college.
Employee Certification Signature
I hereby certify the following:
All items listed above were for College use and no personal purchases were made;
• I will not seek reimbursement in any other manner for this transaction;
• Original documentation is not in my possession for the reasons stated above; and,
• I acknowledge that repeated lack of documentation could result in revocation of my Purchase Card.
________________________________________________ ___________________________________
Employee Signature Date
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General Receipt Template 1