1.        
    1. P-CARD ACTION FORM
      1.        
    2.        Today’s Date: 
      1. Cardholder’s Name:
      2. P-Card Account #:
      3. Supervisor/Budget Head Name:
      4.         
      5. CARDHOLDER: (Check one)
      6.  CHANGED DEPARTMENTS. MAINTAIN CARD PRIVILEGES FOR NEW DEPARTMENT:
      7.  NEW DEPARTMENT:
      8.  NEW DEPARTMENT MAILING ADDRESS & PHONE:
      9.  CHANGED JOB RESPONSIBILITIES. CANCEL CARD PRIVILEGES.
      10.  IS NO LONGER AN EMPLOYEE. CANCEL CARD PRIVILEGES.
      11.  DATE OF TERMINATION:
      12.  IS ON EXTENDED LEAVE FOR MORE THAN 30 DAYS.
      13.  ACTION FOR CARDHOLDER ON LEAVE:  MAINTAIN CARD PRIVILEGES
      14.         SUSPEND CARD PRIVILEGES
      15.         CANCEL CARD PRIVILEGES
      16. DATE ACTION TAKEN: ____________________________________  ______________________


       


P-CARD ACTION FORM

 


             


              Today’s Date:  

 


Cardholder’s Name:



P-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: ____________________________________  ______________________

        P-Card Administrator Signature    Date

 

COMMENTS:

 

Form 3300/013 (7/12)

 

Back to top