Replacement Receipt Form

1. Cardholder: Complete the first three sections ONLY.
2. Approver: Scroll down the page to complete the Approval Section.
1. Cardholder and Transaction Information
This form is used only if the actual receipt, invoice, packing list or internet order form is not available. Completion of this form will only be allowed in extenuating circumstances. A field marked with a red asterisk is required.
Cardholder name*
First Last
Purchase date*
Date Format: MM slash DD slash YYYY
Vendor name*
Vendor phone
City*
State*
Explanation of why receipt is unavailable*
Description of Purchase
Select (+) to add a new row for each product purchased.
List items and quantities*
Description Quantity Price/item Tax Cost
Purpose*
Cardholder Agreement
Statement of agreement*
- I agree and certify that the above purchase was made for WELS business only.
Cardholder name*
Date*
Date Format: MM slash DD slash YYYY
Cardholder e-mail*
A confirmation e-mail will be sent to you after this has been approved.
Enter e-mail Confirm e-mail
Data Privacy & Permission*
I AGREE with the terms of the WELS Privacy Policy.
NOTE TO EU RESIDENTS:

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.
Cardholder: Proceed to the Save and Send for Approval link at the bottom of this form
2. Approval Section ONLY
Step 1: Review all fields completed by the Cardholder.
Step 2: Complete the approval process below and Submit.
Approve*
- By submitting this form, I agree that the above purchase was for business purposes. The Cardholder was reminded that vendor receipts are required for all WELS purchases.
Approver name*
Date*
Date Format: MM slash DD slash YYYY
1. Cardholder: Select the Save and Send for Approval link.
2. Approver: Select the Submit button.

Save and Send for Approval

WELS Finance: treasury@wels.net or 414-256-3260 | Privacy policy
Ref: Replacement Receipt Form

Description	Quantity	Price/item	Tax	Cost