P-Card Receipt Submission Form

P-Card Purchase Form
Name on P-Card used to make purchase: *
Name on P-Card *

First Name Last Name
P-Card holder's e-mail address: *
Is this a travel-related purchase? *

No Yes
Type of travel? *

Domestic Foreign
Is this a vehicle related purchase? *

No State, fuel (yes) State, repair (yes) Rental (yes)
Please select vehicle number for fuel: *
Please select vehicle number for repair: *
Please provide rental agreement # *
Date purchased: *

Month Day Year
Itemized list of purchases: *
Description of item(s):
Total cost: *
Item(s) purchased:
Person/Professor the item was purchased for:
Account to charge: *
Person making purchase (if different from P-Card holder):
E-mail address of the person who purchased the item(s):
Upload receipt(s):

Upload a File

Cancel of
Upload guest list (share funds only):

Upload a File

Cancel of
Should be Empty:

P-Card Purchase Form