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Replacement Receipt Form - UM InfoPoint

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Replacement Receipt Form - UM InfoPoint Powered By Docstoc
					             University of Missouri Purchasing Card Program
                        Replacement Receipt Form

DATE OF PURCHASE: ______________________________


MERCHANT NAME: _____________________________________________________

METHOD OF PURCHASE:            _____ TELEPHONE  _____ FAX            ____INTERNET
                               _____ STOREFRONT

       OTHER: __________________________________________________________


DESCRIPTION OF PURCHASE:




PURCHASE AMOUNT $ __________________________


RECEIPT WAS (CHECK ONE) _______ LOST _______ NOT OBTAINABLE

I, _______________________________________, the undersigned do certify that the above
             (print name)          purchase was made for official University business.




_________________________________________           ______________________________
CARDHOLDER SIGNATURE                                          DATE

NOTE: this form is to serve as a receipt; if a receipt cannot be obtained from the
merchant or from JP Morgan. If JP Morgan cannot provide receipt attach the letter from
JP Morgan to this form and keep for departmental records.

				
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