Cardholder Name: __________________ Dept: ________________ Campus Address: ________________
Email Address: ______________________ Telephone: ____________ DL Number: ___________________
I, as an authorized T-Card holder, fully understand and agree to the following terms and conditions:
1. I as an employee of Arkansas Tech University, fully understand and agree to the following terms and
conditions regarding use and safekeeping of the Travel Card.
2. I agree that all credit limits or changes must be justified and approved by the department Vice President or
the department Dean or Director.
3. I agree to document all Travel Card expenditures and obtain itemized receipts. These will be attached to the
monthly Travel Card Log and signed by my approved supervisor. If my supervisor is unable to sign my log.
I will submit it to the Vice President or Director.
4. I will not accept cash refunds or gift cards in exchange for any credits to the card. I understand that all
credits must be issued directly to the card. I will report any vendors who do not comply with this guideline
5. In the event that I cannot complete my monthly log, due to emergency, illness vacation, or conference I will
notify the Travel Card Office and make arrangements with another trained employee to complete my
monthly log.
6. I understand that if my Travel Card transaction log is late or incorrect and I have not amended the situation
in a timely manner, my Travel Card privileges will be suspended or terminated by the Travel Card
7. I understand it is my responsibility to be aware of my department budget when using the Travel Card.
8. I understand that the Travel Card is to be used for official travel of Arkansas Tech University. I will not use
the card for any unauthorized travel or personal purchases.
9. I understand that the card issued in my name is only to be used by me. I agree to not share my card or card
number with anyone. No other employee’s expenses may be charged to my card. I will be making financial
commitments on behalf of Arkansas Tech University and will endeavor to obtain fair and reasonable prices.
10. I will immediately report the theft or loss of the card to VISA by phone at 1-800-VISA911, to the Travel
Department 356-2034 and to my department head.
11. I will surrender my Travel Card upon (a) termination of employment, or (b) transfer to another department or
(c) if requested by my supervisor or the Travel Office. Further, I understand that my last paycheck will be
withheld until the Travel Card is properly surrendered
12. I have received training for the use of the card and agree to follow all established procedures. I understand
that I may be required to receive retraining when notified by the Travel Office due to changes in state travel
13. I understand that failure to follow any of the above listed terms and conditions or if found to have misused
the Travel Card may result in (a) revocations of the privilege to use the card, (b) disciplinary action, (c)
termination of employment and/or criminal charges being filed with the appropriate authorities.
I hereby accept the above terms and conditions:
________________________ __________________________ _________________
Employee (printed name) Employee Signature Date Signed
I, as Department Head, assign Index _________ with an established monthly limit of $_________to be used
for all charges related to the use of this T-Card.
__________________________ ______________________________ _________________
Department Head (printed name) Department Head Signature Date Signed
Approved by:
__________________________ _______________________________ ________________
Vice President (printed name) Vice President Signature Date Signed
T-Card Issued By: __________________________ Date Issued: __________________
T-Card No: __________________ _________________________________________
Signature of Cardholder (acknowledging receipt of card)
click to sign
click to edit
click to sign
click to edit
click to sign
click to edit
click to sign
click to edit