Series - 704.2.3.2P - Procurement Card Application and Change Form

Cardholder Name:

Employee ID#:

Site/Location:

District E-mail Address:

@district196.org

FOR NEW CARD APPLICATION USE ONLY:

Monthly Dollar Limit:

One Time Purchase Limit:

Default Accounting Code

Cardholder Signature:

Date:

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.

FOR CHANGE TO AN EXISTING CARD USE ONLY:

Cardholder’s Name Change:

Change single purchase limit to:

Change monthly limit to:

Deactivate card (include date of deactivation):

Cardholder Site Change:

Other:

Default Accounting Code Change to:

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.

Principal/Dept. Supervisor Signature

Date:

Program Administrator Approval & Date:

Agreement Received:

Card Ordered: