1.        
    1. PURCHASING CARD
    2. CARDHOLDER ENROLLMENT FORM
      1.            
      2. THIS FORM SUPERCEDES PREVIOUSLY SUBMITTED FORM FOR THIS CARDHOLDER.
      3. CHECK ALL THAT APPLY:
      4.  NEW CARDHOLDER NEW PROXY of NEW APPROVER of
      5.   Department: Department:
      6.       
      7.    CHANGE INFORMATION ON EXISTING USER ACCOUNT
      8. Name:         ( maximum of 26 spaces)
      9. Department:       Employee ID#:
      10. Office Mailing Address:
      11. City, State, & Zip:
      12. Phone #:      E-mail:


       


PURCHASING CARD


CARDHOLDER ENROLLMENT FORM


                     


THIS FORM SUPERCEDES PREVIOUSLY SUBMITTED FORM FOR THIS CARDHOLDER .

 


CHECK ALL THAT APPLY:


 NEW CARDHOLDER  NEW PROXY of  NEW APPROVER of


   Department:  Department:


           


   
   CHANGE INFORMATION ON EXISTING USER ACCOUNT

 (Describe Change (ex. Default Budget, Transaction/Spending Limits, Department, Mailing Address, etc.)

 

 

 

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Section I:   (Note: Name must be same name on record in Human Resources for cardholders.)


Name:                ( maximum of 26 spaces)


Department:            Employee ID#:


Office Mailing Address:

  


City, State, & Zip:


Phone #:            E-mail:

 

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Section II:   (To be completed by Supervisor/Budget Head)

Single Transaction Limit:      

 (Maximum $1000)

FUND:        ORGN:         ACCOUNT:

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Signatures/Approvals:

 

SUBMITTED BY:_______________________________________  DATE:________________________

 

APPROVED BY:________________________________________ DATE:________________________

   Supervisor/Budget Head

 

APPROVED BY:_________________________________________  DATE:________________________

   Budget Head (only required if Supervisor is not Budget Head)

 

APPROVED BY:________________________________________  DATE:________________________

    Appropriate Vice Chancellor

 

APPROVED BY:________________________________________ DATE:________________________

    Assistant Vice Chancellor/Controller

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Date Application Processed by Controller’s Office:____________________________

 

Submitted To Card Issuer By: ____________________________  Date: ________________________

Form 3300/010 (9/11)

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