Date of Purchase Receipt Total Short Description of Purchase Vendor or Supplier Check-off if Check-off if receipt is U-Billed (Example: 6/10/2014) (Example: $15.34) (Example: Food, Bus Fare, Personal Items/Toiletries) (Example: HyVee, Target, attached Essentials, etc.) Total spent with cash advance: ______________________________ Total U-Billed: ____________________________________
Date of Purchase (Example: 6/10/2014) Receipt Total (Example: $15.34) Short Description of Purchase (Example: Food, Bus Fare, Personal Items/Toiletries) Vendor or Supplier (Example: HyVee, Target, Essentials, etc.) Check-off if receipt is attached Check-off if U-Billed Total spent with cash advance: ______________________________ Total U-Billed: ____________________________________