Revised 11/2011
Unavailable Documentation
Procurement Card Program
Cardholder Information
Cardholder Name:
Date Issued:
Transaction Information
Transaction Date:
Transaction Amount:
Merchant Name:
Item Description
Per Item Cost
Total Cost
Transaction Total:
Cardholder Explanation
Please attach any additional information, correspondence, or justification about this transaction
Cardholder Acknowledgment & Certification of Signature
I certify that all items in this P-Card transaction were made for the School and that no personal purchases were
made. I understand that for every transaction a detailed itemized receipt is required to be kept on file for 3 years
unless otherwise required for a Sponsored Project. I will keep this form with my other receipts as acknowledgement
of the unavailable documentation.
Cardholder Signature
Approving Officials' Signature

Document Outline