P-card reconciliation Form by dbh92952

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									             DIVISION                             CARDHOLDER NAME (LAST, FIRST)

                                 PURCHASING CARD RECONCILIATION FORM
        (1) PCARD #:                                                           (2) DIV CONTACT NAME:

        (3) PHONE #:                                                           (4) LOCATION:                     (5) ADM:

(6) ITEM PURCHASED:                               (7) COMPANY            *(8) ACCOUNT NO.* (9) CENTER          (10) 1099 CODE (11) RECEIPT AMOUNT




                                                                                                                                                               $0.00
                                    *Do Not Use this form to reconcile purchases to Account Numbers 532711 - 532729 and 532930; however,
                                    this form must be sent along with the approved Travel Reimbursement Form. A valid, approved Travel
                                    Reimbursement form should be used for these types of reconciliations.*

Justification:




Authorized Signature                                                                       Date
                        Cardholders cannot sign their own Pcard forms.


                        All purchases made with the State Purchasing Card are Sales Tax Exempt. If additional lines are needed, use another Pcard
                        Reconciling Form to continue listing purchases. Complete and submit this form along with the receipts within 5 - 7 business days
                        from the date of purchase.

                        Sales/Order forms/Packing slips are not required for reconciling and CANNOT be used in place of the receipt.

                        Please remember that use of the procurement card is a privilege. The same purchasing laws, rules and policies still apply. The use
                        of term contracts is mandatory by state law. State purchasing procedures and guidelines may not be circumvented by the use of
                        the Purchasing Card. Anyone found in violation of these policies will be subject to having his/her card revoked and/or
                        disciplinary action will be taken which could include termination.
DENR OC 34                                                                                                                                                   rev. 5-13-10
DO NOT MODIFY THIS FORM IN ANY WAY
(Fields and Font sizes are specifically set for bar code scanning.)

Div: Select your Division from the dropdown box.
Cardholder Name: Type Cardholder name in format Last Name, First.

1) Type the Cardholder's 16 digit card number.
2) Type the name of the Division's p-card contact.
3) Type the phone # for the Division's p-card contact.
4) Type the 4 digit location # for your division.
5) Type the 4 digit admin # for your division.
6) List each item purchased - please be specific.
7) Type the G/L company to be charged for the purchase.
8) Type the G/L Account to be charged for the purchase. (Make sure the account # is correct fo
regulations per the note at the bottom of the form.)
9) Type the G/L Center to be charged for the purchase.
10) If applicable, type the appropriate 1099 code for the purchase. 1099 codes are required for goo
(INC) businesses.
11) Type the total amount on the receipt.

Travel Expenditures: A P-card reconciliation form must be completed and sent along with the Trav
purposes. Only the Division and Cardholder name need to be completed.

Justification: Use this box for late justification, purchases made outside the STC process, over limi
further explanation needed for the purchase.

Signature: The person approving the cardholder's purchase signs here, such as a supervisor, the div

Please remember that use of the procurement card is a privilege. The same purchasing laws, r
contracts is mandatory by state law. State purchasing procedures and guidelines may not be c
Anyone found in violation of these policies will be subject to having his/her card revoked and/
include termination.
 account # is correct for the item purchased as well as following all travel


des are required for goods and services purchased from non-incorporated




ent along with the Travel Expense Reimbursement Form for scanning


STC process, over limit purchases, non-DOC purchases, or any other


as a supervisor, the div p-card contact, etc. The cardholder cannot sign here.

me purchasing laws, rules and policies still apply. The use of term
uidelines may not be circumvented by the use of the Purchasing Card.
her card revoked and/or disciplinary action will be taken which could

								
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