Credit Card Summary - Wartburg College - Waverly_ Iowa_ USA by suchenfz


									                                                       WARTBURG COLLEGE
                                         WELLS FARGO - CREDIT CARD STATEMENT SUMMARY

1. Complete this form from information on your Wells Fargo statement that you obtain on-line. * The green shaded areas should be completed as
   applicable. The yellow shaded area is a formula and should not be changed.
2. Agree the "Total Payment" amount on this form to the total on the Wells Fargo statement you obtain on-line. *
3. Obtain appropriate approval(s).
4. Submit this form with the original related invoices or detail itemized receipts by the 13th of the month.

* The statement dates run from the 5th of one month to the 4th of the next month. Cathi Duitsman or Kristi Ladage can provide you with
instructions for on-line access or they can provide you with a copy of your statement.

                                            CARDHOLDER NAME:                                                     STATEMENT DATE:

                                                                                                        12 DIGIT ACCOUNT                                        FISCAL
  TRANS.                  VENDOR & DESCRIPTION                                                       NUMBER TO BE CHARGED                                        YEAR
   DATE                   (LIMITED TO 40 SPACES)                         ACCOUNT NAME               (EXAMPLE 00-810-730-0000)              AMOUNT             (e.g. 05-06)

                                                                                                            Total Payment                             $0.00

Approved for Payment:

                                                                                                 I hereby certify that this is a true statement of
Department Head or Advisor                  Date                                                 expenses incurred related to official business for
                                                                                                 Wartburg College.
Approved for Payment (required if travel expenses were incurred)

                                                                                                 Cardholder's signature                               Date
Vice President or President                 Date

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