PURCHASING CARD ACTION FORM
Today’s Date:
Cardholder’s Name:
Purchasing Card Account #:
Supervisor/Budget Head Name:
CARDHOLDER: (Check one)
CHANGED DEPARTMENTS. MAINTAIN CARD PRIVILEGES FOR NEW DEPARTMENT:
NEW DEPARTMENT:
NEW DEPARTMENT MAILING ADDRESS & PHONE:
CHANGED JOB RESPONSIBILITIES. CANCEL CARD PRIVILEGES.
IS NO LONGER AN EMPLOYEE. CANCEL CARD PRIVILEGES.
DATE OF TERMINATION:
IS ON EXTENDED LEAVE FOR MORE THAN 30 DAYS.
ACTION FOR CARDHOLDER ON LEAVE: MAINTAIN CARD PRIVILEGES
SUSPEND CARD PRIVILEGES
CANCEL CARD PRIVILEGES
APPROVED BY:________________________________________ DATE:___________________________ Supervisor/Budget Head
APPROVED BY:________________________________________ DATE:___________________________
Budget Head (if Supervisor is not also Budget head)
APPROVED BY:________________________________________ DATE:___________________________
Appropriate Vice Chancellor
DATE ACTION TAKEN: ____________________________________ ______________________
Purchasing Card Administrator Signature Date
COMMENTS:
Form 3300/013 (12/09)