Replacement Receipt Form

Cardholder and Transaction Information
This form is used only if the actual receipt, invoice, packing list or internet order form is not available. Please save a .pdf or print the confirmation screen and upload to the WellsOne Expense Manager in place of your missing receipt. A field marked with a red asterisk is required.
Cardholder name*
First Last
Last 4 digits of Wells Fargo Credit Card*
Include leading zeros if any.
Purchase date*
MM slash DD slash YYYY
Vendor name*
Vendor phone
City*
State*
Description of purchase*
Select (+) to add a new row for each product purchased.
Item Price
Business Purpose of Purchase*
Explanation of why receipt is unavailable*
Certification
Statement of agreement*
- I agree and certify that the above purchase was made for WELS business only.
Submitter name*
Submitter e-mail*
A confirmation e-mail will be sent to this address.
Enter Email Confirm Email
Data Privacy & Permission*
I AGREE with the terms of the WELS Privacy Policy.
NOTE TO EU CITIZENS, RESIDENTS, TOURISTS, AND OTHER PERSONS TEMPORARILY IN THE EU:

By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy.

WELS Finance: [email protected] or 414-256-3260 | Privacy policy
Ref: Replacement Receipt Form

Item	Price