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					                                                                                    SPOTS Card Procurement Activity Log B - High Volume
                                                                                                                                                                          Cardholder's Name: Last, First
                                                                                                 Date (month/year): Month-YYYY                                   Card Number (the last 6 digits): 0
                                                                                                 Cardholder E-mail: first.last@state.or.us                        Department / Division / Office:
                                                                                                                                                                                Phone Number:
              l                                                                                                                                                        SPOTS Card Credit Limit:                $        5,000.00
                                                                                                                                                                                                                                             Quantity      Quantity
                                                                                          Original                                                                          Quantity        On       Transaction/                           Received      Remaining
Transaction                       Tracking       Purchase/Credit         Department/      Quantity     Total Credit/ Cost or Credit per                                    Received     Statement?    Statement     Available Credit on      (prior to    (after this
    Date          Vendor Name      Number          Description         Client/Requestor   Ordered    Purchase Amount        Item               Index   PCA   Object Code   this Cycle      (Y/N)       Amount              Card             this cycle)     cycle)
                                                                                                                                                                                                                                                               0
                                                                                                                                                                                                                                                               0
                                                                                                                                                                                                                                                               0
                                                                                                                                                                                                                                                               0
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Insert Row                                                                                                                                                                     0

                                                                                                                                                                               0
                                                                                                                                                                     Total charges (must not exceed credit limit)                  -
              Cardholder's signature                                        Date                                                                                   Total charges not Included on bank statement $                  -
              By signing this document I certify all purchases were for state business and the log has been reconciled to the                                        Monthly bank statement total (must match) $                   -
              monthly bank statement and original receipts.




              Approving Manager's Signature                                 Date                     Approving Manager's Printed Name
              By signing this document I am certifying I have verified that the Approving Manager has delegated purchase approval authority and
              that delegated expenditure authority was received for each transaction. I am also certifying that I have verified that the card holder
              has reconciled their log to the bank statement and original receipts, and that all purchases were appropriate to further the official
              business of the State.
Y
                                                                                                                                                                               0
                                                                                                                                                                               0




                                                                                                                                          1 of 3                                                                                          DHS 115B (01/11)
                                                                            SPOTS Card Procurement Activity Log B - High Volume
                                                                                                                                                               Cardholder's Name: Last, First
                                                                                    Date (month/year): Sep-2010                                       Card Number (the last 6 digits): 0
                                                                       Cardholder or Facilitator E-mail: first.last@state.or.us                                Department/Branch:
                                                                                                                                                                    Phone Number:
              l                                                                                                                                            SPOTS Card Credit Limit: 
                                                                                Original    Total Credit/                                                      Quantity        On
Transaction                     Tracking   Purchase/Credit     Department/      Quantity     Purchase       Cost or Credit                                     Received    Statement?      Transaction/
    Date          Vendor Name    Number      Description     Client/Requestor   Ordered       Amount          per Item            Index   PCA   Object Code   this Cycle      (Y/N)     Statement Amount
                                                                            Original   Total Credit/                                                 Quantity                    Transaction/                         Quantity          Quantity
Transaction                 Tracking   Purchase/Credit     Department/      Quantity    Purchase       Cost or Credit                                Received    On Statement?    Statement     Available Credit   Received (prior   Remaining (after
    Date      Vendor Name    Number      Description     Client/Requestor   Ordered      Amount          per Item       Index   PCA   Object Code   this Cycle        (Y/N)        Amount           on Card         to this cycle)     this cycle)

				
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posted:9/19/2011
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