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:
      13. Single Transaction Limit:    
      14.  (Maximum $1000)
      15. FUND:     ORGN:      PROGRAM:
      16. Signatures/Approvals:



       



PURCHASING CARD



CARDHOLDER ENROLLMENT FORM



                     



THIS FORM SUPERCEDES PREVIOUSLY SUBMITTED FORM FOR THIS CARDHOLDER .

 



CHECK ALL THAT APPLY:


NEW CARDHOLDER NEW PROXY ofNEW 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:          PROGRAM:
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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/Executive Dean
 

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 (8/15)

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