"Documentation of Lost or Unavailable Transaction Information Form" - Colorado

Documentation of Lost or Unavailable Transaction Information Form is a legal document that was released by the Colorado Department of Military and Veterans Affairs - a government authority operating within Colorado.

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Download "Documentation of Lost or Unavailable Transaction Information Form" - Colorado

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Documentation of Lost or Unavailable Transaction Information Form
This form is required for any procurement card transaction that does not have documentation from the
merchant. Frequent occurrences of lost or a lack of documentation may result in the revocation of
procurement card privileges.
Documentation from the merchant is required for all transactions. Documentation includes:
- Receipt and card transaction slip from the merchant
- Packing slip from the delivery
- Invoice showing credit card payment
- Order form for dues, memberships, subscriptions or similar items
Information
Transaction Reference # ________________
Cardholder _______________________
Date of Purchase ________________
Approving Official __________________
Merchant ______________________
Department _______________________
Description, Quantity, Cost for each Item Purchased
Description
Quantity
Unit Cost
Total Cost
Total Cost
Attach any additional information, correspondence or justification about this transaction.
Reason Original Documentation Is Not Available
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________________ ______________________________
______________________
Date
Cardholder (printed name)
Cardholder Certification Signature
___________________ _______________________
______________________________
Date
Approving Official (printed name)
Approving Official (signature)
Documentation of Lost or Unavailable Transaction Information Form
This form is required for any procurement card transaction that does not have documentation from the
merchant. Frequent occurrences of lost or a lack of documentation may result in the revocation of
procurement card privileges.
Documentation from the merchant is required for all transactions. Documentation includes:
- Receipt and card transaction slip from the merchant
- Packing slip from the delivery
- Invoice showing credit card payment
- Order form for dues, memberships, subscriptions or similar items
Information
Transaction Reference # ________________
Cardholder _______________________
Date of Purchase ________________
Approving Official __________________
Merchant ______________________
Department _______________________
Description, Quantity, Cost for each Item Purchased
Description
Quantity
Unit Cost
Total Cost
Total Cost
Attach any additional information, correspondence or justification about this transaction.
Reason Original Documentation Is Not Available
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________________ ______________________________
______________________
Date
Cardholder (printed name)
Cardholder Certification Signature
___________________ _______________________
______________________________
Date
Approving Official (printed name)
Approving Official (signature)
Instructions: Documentation of Lost or Unavailable Documentation
Warning
Repeated use of this form as substitute for original documentation may result in
:
revocation of the Cardholder's procurement card.
This form is required for any transaction that is not supported by documentation from the
merchant.
Cardholder Instructions
If you do not have the original documentation from the merchant, contact the merchant to
request replacement documentation.
Complete this form whenever you are unable to provide documentation from the merchant
for a transaction.
Fill out all fields through Cardholder Certification Signature.
Give the completed and signed form to your Approving Official.
Approving Official Determination Instructions
Determine the Violation Status for the transaction based on the following guidelines.
Violation – A transaction where the Cardholder has not provided documentation from the
merchant but the charge appears to be reasonable for state business is to be considered a card
violation. A Procurement Card Violation Warning Form does not need to be completed if the
Approving Official and the Program director agree that there was no willful or negligent
action on the part of the Cardholder and the charges appear reasonable for state business.
Considerations in determining willful or negligent default include:
a) The Cardholder has tried and been unable to obtain documentation from the merchant.
b) The Cardholder is normally responsible and consistent with providing acceptable
documentation.
Action: A copy of this completed form is to be kept with the Cardholder’s statement that
lists this transaction.
Violation and Potential Inappropriate Purchases – A transaction where the Cardholder
has not provided documentation from the merchant and the charge does not appear to be
reasonable for state business.
Action: A Procurement Card Violation Warning Form needs to be completed.
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