Purchasing Card Application To be completed by applicant

Purchasing Card Application To be completed by applicant: (please print, using your legal name) Date: _________ Employee ID __________ First Name________ Initial ____ Last Name ___________ Department ____________ Title _____________ Work Phone ____________ Email ____________ Default is Monthly Card Limit $5000 / Single Transaction Limit $3000 Note: If you require limits which are different then those stated above please list your reasons. ____________________________________________________________________ Type of transactions you will be making on your P-Card (check all that apply): ____ Travel / Meals ____ Postage ____ Hospitality ____ Instructional Material Other (describe): ______________________________________________________________ Required Authorizations: ______________________________________ Applicant Name - print Signature Date ______________________________________ Approver Name - print Signature Date (Dean or Manager) ______________________________________ Dept. VP or Provost - print Signature Date To be completed by Business Office: Date received ______ Reviewed by ____________ Date ____ Approved Declined Reviewed by ____________ Date ____ Card Ordered by __________ Date ____