FLORIDA POLYTECHNIC UNIVERSITY
EXPENSE CARD PROGRAM
CARDHOLDER PROFILE
Date: ___/___/___
Action Requested
Request new card
Change existing profile
Close Account – complete termination form
Other:
Cardholder Name:
Employee ID Number:
Mother’s Maiden Name:
Department:
Business Address:
Phone:
Fax:
e-mail:
Requested Monthly Limit: $ (Maximum Initial Amount:$5,000)
Single Transaction Limit: $ (Maximum: $2,500)
Director Signature:
Cost Center Manager Signature:
(if other than Director)
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Director of Procurement or Designee (Print):
(print)
(sign)
(date)
CARD TYPE (Check One)
[ ] Commodities Only
[ ] Commodities & Travel *
* Requires Travel Addendum
10.17.2017 v3
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