Gift Card Purchase Request Form

This form is used to purchase non-cash valuables such as gift cards, bus passes, diaper vouchers, etc.  Note that all non-cash valuables that are not immediately distributed must be kept in a locked location. The following are required for all non-cash valuables
  1. Inventory – an inventory must be kept of all non-cash valuables that is updated with each disbursement
  2. Disbursement Log – a disbursement log is required to record the disbursement of all non-cash valuables purchased. The log must contain the name and signature of the employee disbursing the item, the recipient’s name as well as the description and worth of the item.
  3. Reconciliations – the program must be able to reconcile all non-cash valuables purchased/disbursed.
  4. Receipts – all purchases require detailed receipts of what was purchased, when the purchase was made and the cost of the purchase.
    • All receipts must be turned into the individual responsible for the purchase and tracking of items.
    • All receipts and updated disbursement logs must be retained for audit purposes.
    • Program staff should monitor quantities remaining and know when to procure more items.
    • The Fiscal Department will conduct periodic audits to ensure programs have fully complied with the non-cash valuable requirements.
 
Fiscal - Gift Card Purchase Order

Requester Information

Name
Name
First
Last

Fiscal Information

Please enter your Grant Number OR General Fund DAX String below (Click here for the DAX Conversion Listing)

Order will not be processed without correct fiscal information.

G50XXXX
i.e. 2250, 2251, etc
i.e. CW001, HE002, etc
i.e. 500XXX
i.e. HE09, HE27, etc

Card and Program Information

$
Is Purchase Allowable Per Funder?

Maximum file size: 5MB

Attach funder documentation

Approvals

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