Series - 704.2.3.2P - Procurement Card Application and Change Form
Adopted: April 2019
Revised:
Each Procurement Card application or change requires approval from the Principal/Department Supervisor. The Procurement Card Program Administrator will review the application and/or change to ensure the applicant’s intended usage meets district criteria and will issue a Procurement Card or change authorization when appropriate.
Cardholder Name: |
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Employee ID#: |
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Site/Location: |
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District E-mail Address: |
@district196.org |
FOR NEW CARD APPLICATION USE ONLY: |
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Monthly Dollar Limit: |
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One Time Purchase Limit: |
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Default Accounting Code |
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Cardholder Signature: |
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Date: |
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When applying for a new account, the Procurement Card Agreement must be read, signed and dated by the applicant and submitted to the Procurement Card Program Administrator before a card will be issued. |
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FOR CHANGE TO AN EXISTING CARD USE ONLY: |
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Cardholder’s Name Change: |
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Change single purchase limit to: |
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Change monthly limit to: |
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Deactivate card (include date of deactivation): |
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Cardholder Site Change: |
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Other: |
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Default Accounting Code Change to: |
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As Principal/Department Supervisor, I hereby grant this applicant authorization to apply for or change, and use, the Independent School District 196 Procurement Card. I will review our site budget limitations and Policy 704 Expenditures with the applicant. I agree to review and approve the monthly Procurement Card statements issued to this applicant. If the applicant’s employment with the district is terminated, I agree to immediately request return of the Procurement Card and notify the Procurement Card Program Administrator. |
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Principal/Dept. Supervisor Signature |
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Date: |
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********** The following is to be completed by the District Finance Department **********
Program Administrator Approval & Date: |
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Agreement Received: |
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Card Ordered: |
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Procedure 704.2.3.2P/4-1-19