Purchasing Card Application
Contents
1. Please print this form and deliver with original signatures to Business Services Attention P Card Administrator UNIVERSITY Purchasing Card Business Services Use Only DENVER Application See Listserv Follow Up Cardholder Information First Name Mi _____ Last Name Title Department Name _ Address of Your Building CellPhone __ M Business Phone Date of Birth Banner ID Number have obtained a copy of the University of Denver Purchasing Card User Manual and understand my responsibilities and that failure to follow the rules and requirements may result in loss of P Card privileges Signature of Applicant Date Email Address Card Coordinator Default FOAP Division Resp Crt Fund Org Acct The Card Coordinator reviews the Cardholder s purchases for necessary documentation and compliance with policies and procedures Printed Name of Card Coordinator Email Address Signature of Card Coordinator Date Approval Signatures Higher Level Approver The Higher Level Approver reviews the Cardholder s purchases for appropriateness Printed Name and Title of Higher Level Approver Signature Date 1 Please Circle Yes or No for each question 2 Cardholder will use their card choose only one Yes No This employee can use their card for travel expenses _ Domestic travel only Yes No This employee will make card purchases with grant funds L Domestic and International travel Vice Chancellor De2. an or Division Director Printed Name and Title of Vice Chancellor Dean or Division Director Signature Date ORSP Approved if applicable __ Signature Date UNIVERSITY eo Purchasing Card DENVER Agreement Your participation in the DU Purchasing Card Program is a privilege that carries responsibilities along with it Although the card is issued in your name it should be considered University property and should be used with good judgment Your signature below verifies that you understand the following Purchasing Card Program guidelines and agree to comply with them 1 10 l understand the Purchasing Card is provided to employees based on their need to purchase University related goods and services and that my card may be revoked at any time based on change of assignment or location it is not an entitlement nor reflective of title or position understand the card is for University related purchases only will not make personal charges with the card DU is a tax exempt organization and is generally exempt from state sales tax Because taxation applies to personal charges this misuse of the card can have harmful repercussions for the University understand the card is issued in my name and I am responsible for any and all charges made against the card understand improper use of the card can be considered misappropriation of University funds This may result in disciplinary action up to and including termination
3. understand all charges will be billed directly to and paid directly by the University The bank cannot accept any monies from me directly therefore any personal charges billed to the company could be considered misappropriation of company funds understand am expected to comply with University policies and procedures in order to protect University assets this includes keeping original itemized receipts reconciling monthly memo statements meeting submittal deadlines and following proper card security measures understand am responsible for reviewing my charges and resolving any discrepancies by contacting the supplier first and then US Bank at the number on the back of my card as a final resort if the supplier is unresponsive understand each account is assigned a default FOAP and purchases that are not reviewed will be automatically charged to that FOAP at each accounting month end understand if my card is lost or stolen will report it immediately by telephone to US Bank at 800 344 5696 along with a follow up email to the DU program administrator Any required fraud paperwork must be submitted to the bank and the DU program administrator immediately A agree to surrender my card upon termination of employment whether for retirement voluntary or involuntary reasons no further use of the card is authorized understand and agree to comply with the terms of this Purchasing Card Agreement Cardholder Signature Date
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