FORM #3
MISSING ITEMIZED RESTAURANT RECEIPT
C
ardholder: S
tatement Closing Date:
**Before submitting this form, try to contact the vendor for a copy of the itemi
zed receipt. If you are unable to get a copy from the vendor then enclose this f
orm in your p-card log.
DATE VENDOR ITEM DESCRIPTION AMOUNT
Cardholder Signature Date
Dean/Supervisor Signature Date