Travel Card Reconciliation

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					                                            Travel Card Reconciliation
               (Send to Accounts Payable by the 15th of the month following the Billing Cycle)


   Cardholder:
  Billing Cycle:
 Travel Details:
 [Include: Date(s),
  Destination(s) &
 Purpose of Travel]


*If additional space is required to complete reconciliation, include separate sheet showing detail.
        Transaction Detail w/Accounting Code Report
Report Total:                        $    0.00
Minus Total of Receipts:             $    0.00           Explanation of Items to Reconcile
Minus Items to Reconcile:            $    0.00
(disputed, no receipt, etc.)         $    0.00
                                     $    0.00
                                     $    0.00
                                     $    0.00
                                     $    0.00
Reconciliation Balance
(Should Always be Zero)              $    0.00    0.00



        Gas Charges - University Vehicle
Date of Expense(s)                        Amount         Account Charged in Paymentnet.com
                                     $    0.00
                                     $    0.00
                                     $    0.00
                                     $    0.00
Total Gas Charge(s):                 $    0.00    0.00


        Cash Advance Itemization
Date of Expense(s)                        Amount         Description of Expense(s)
                            $             0.00
                            $             0.00
                            $             0.00
                            $             0.00
Total Cash Expense(s):      $             0.00    0.00
Less Total Cash Advance(s): $             0.00
Excess Cash Returned:       $             0.00    0.00


        Personal Expenses
Date of Expense(s)                      Amount           Account Charged in Paymentnet.com
                                     $ 0.00
                                     $ 0.00
                                     $ 0.00
Total Personal Expense(s):           $ 0.00  0.00

Print completed form, obtain original                            Print completed form, obtain original
signatures and forward to Finance, A/P.          Apr 26, 2004    signatures and forward to Finance, A/P.    Apr 26, 2004

Cardholder/Record-Keeper                         Date             Budget Manager                           Date

                                                     CLEAR FIELDS
Last Revised: 3/29/04