The URL can be used to link to this page

Home My WebLink AboutInv# PC - 4303 - UNITED STATES POSTAL SERVICE - 04/30/2022Updated June 2019 Lost/Missing Receipt Form for P-Card The City of Dania Beach expects your best efforts to obtain original receipts. In the rare event that a receipt cannot be obtained, or is lost, this form may be used to document your purchase. Excessive use of this form could result in suspension of purchasing privileges. Supervisor approval is required. Card Holder Information Vendor Information Name: ____________________ Last 4 of CC: _______ Name: _____________________________ Department: ___________________ Phone #: ________________ Purchase Date: ______________________ Purchase Information ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________  I certify this purchase is a valid City expense  I certify this purchase will not be submitted on any other form for reimbursement Line Item Detail: Please provide the item description, quantity, and total for each item on the receipt. Quantity Item description Individual amount Total _____________________________________________________________________ Cardholder’s Signature Date _____________________________________________________________________ Department Head or Direct Supervisor’s Signature Date Please provide details as to why the original receipt is not available and how the problem will be avoided in the future. Shipping: Invoice Total: *If more items were purchased, please continue on separate page.