purchasing card receipt submittal form

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					                           DEPARTMENT OF ENVIRONMENTAL PROTECTION

                           PURCHASING CARD RECEIPT SUBMITTAL FORM


CARDHOLDER NAME:                                       FLAIR INV#:

VENDOR:                                          BLDG/VEH/PROP #:

COMMODITY DESCRIPTION:

PURPOSE/JUSTIFICATION:




                              *TAPE RECEIPT HERE OR ATTACH*

                                ONLY ONE RECEIPT PER PAGE




I CERTIFY GOODS/SERVICES HAVE BEEN SATISFACTORILY RECEIVED AND PAYMENT IS NOW DUE.

Cardholder Signature: __________________________________

Date: __________________



DEP 55-310 (06/2011)

				
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