Purchase Log Printed First & Last Name of Cardholder: For Month and Year Page __ of ___ (26th to 25th of each month) Organizational Symbol: Description of Supply Item or Order Name /City/State of Supplier Qty Unit Unit Total Date Amount Control # & Service Date (first & last) of Price Price Billed Name of Supplier’s Rep Rcv’d Requester (first & last name) Issue Issuer 1 Item/Service: Supplier: Location: Requester: Rep’s Name: 2 Item/Service: Supplier: Location: Requester: Rep’s Name: 3 Item/Service: Supplier: Location: Requester: Rep’s Name: 4 Item/Service: Supplier: Location: Requester: Rep’s Name: 5 Item/Service: Supplier: Location: Requester: Rep’s Name: 6 Item/Service: Supplier: Location: Requester: Rep’s Name: 7 Item/Service: Supplier: Location: Requester: Rep’s Name: Memo to Purchase Log: Date: Statement: Disputed items: Cardholder Signature: Date: D-1
Purchase Log Page __ of ___ Printed First & Last Name of Cardholder: Organizational Symbol: For Month and Year (26th to 25th of each month) Description of Supply Item or Service Requester (first & last name) Order Date Name /City/State of Supplier Supplier’s Rep (first & last) Qty Unit of Issue Unit Price Total Price Date Rcv’d Amount Billed Control # & Name of Issuer 1 Item/Service: Requester: Supplier: Location: Rep’s Name: 2 Item/Service: Requester: Supplier: Location: Rep’s Name: 3 Item/Service: Requester: Supplier: Location: Rep’s Name: 4 Item/Service: Requester: Supplier: Location: Rep’s Name: 5 Item/Service: Requester: Supplier: Location: Rep’s Name: 6 Item/Service: Requester: Supplier: Location: Rep’s Name: 7 Item/Service: Requester: Supplier: Location: Rep’s Name: Memo to Purchase Log: Date: Statement: Disputed items: Cardholder Signature: Date: D-1