PURCHASE CARD LOG - U.S. Department of the Treasury
|PURCHASE CARD LOG |Cardholder |Approving Official |BILLING CYCLE ENDING |PAGE |
| | | |8th of MONTH YEAR | |
| |Name: | | | |
| |Phone: | | | |
| | | | | | |
|Order# |Vendor: | |ORDERED |RECEIVED |PURCHASE CARD STATEMENT |Funds |
| |Name |Description | | |Dispute Tracking | |
| |Address |Of | | | | |
| |Telephone |Supplies and Services | | | | |
| | | | | | | |
| |Name of Vendor Representative | | | | | |
| |(&Taxpayer ID #, If 1099 buy) | | | | | |
|Order Date | | | | | | |
Requisition
or 2785 # | | |Qty
&
Unit of Issue |Unit
Price |Total
Price
(Including
Discount,
Shipping &
Handling) |
Ship-ment
Due
Date |Receipt
Date
(Include if
partial recept) |Statement
Date,
Reference
Number &
$ Amount
Billed |Credit
Due
Or
# Items
Due |Data
Dispute
Form
Faxed
To
Citibank |Statement
Date &
$ Credit
or
# Items
Received |
$_____
Running
Balance | |MAC
SOC (CQ #) | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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