Contracts, Procurement & Risk Management
Revised 7/27/2017
CSU Channel Islands
Procurement Card Application
RETURN FORM
T
O:
Procurement
Office
Lindero Hall
Please complete the following information for each card requested. The cardholders name will
appear on the credit card exactly the way it reads on this form.
Cardholder will be responsible for making direct contact with vendors and ordering commodities
using the procurement credit card. Cardholders will prepare monthly reconciliation of credit card
purchases in PeopleSoft. Cardholders with purchases will be audited by Procurement on a
monthly basis.
Monthly Limit: $
(Increments of $100 only)
Daily Limit: $
(Increments of $100 only)
Default Chartfield:
Account Fund Department Program Project
Cardholder’s Name:
Cardholder’s Employee ID#:
Cardholder’s Signature:
Office Phone Number:
Approving Official’s Name:
Approving Officials Signature
For Procurement Office Use Only
Participation Approval:
Director, Procurement Date: _______
Card
Ordered
by: Date: _______
H
R
no
t
ified of n
ew
card
hold
er
D
ate:
_______
CICMP
Contracts, Procurement & Risk Management
Revised 5/4/2017
California State University Channel Islands
Procurement Card (P-Card) Program Agreement
Name of Cardholder
Department Phone Extension No. __________
The Cardholder agrees to accept the responsibility for use of the P-Card for authorized purchases for official University business
only. The Cardholder has received training for the P-Card and is responsible for ensuring the purchases made via the P-Card are
in accordance with the CSU Channel Islands P-Card Handbook.
Specifically, the Cardholder is responsible for security of the card, appropriate use of the card, timely and accurate on-line approval
and reconciliation of transactions, ensuring original receipts are obtained for all transactions, making advance preparation for
monthly statements when planning to be out of the office, immediate reporting of fraud, lost or stolen card to US Bank, and follow
up on resolution of all disputed charges.
The Cardholder must complete the monthly on-line approval and reconciliation of transactions for each billing cycle within five
working days of notice by Procurement Coordinator of the close of the billing cycle. The Cardholder must also forward to their
Authorizer a printed statement and attach original, itemized receipts/invoices, and backup documentation for approval. The original
statement and receipts/invoices shall be kept by the cardholder for five (5) years. This is a mandatory requirement.
Should the Cardholder want to terminate the P-Card or if the Cardholder transfers to another department, the
Cardholder must obtain all receipts of transactions for the current billing cycle (if any), provide these receipts to the Authorizer,
and return the P-Card, in person, to the Procurement Office. Should the Cardholder terminate employment from the University,
the Cardholder must obtain all receipts of transactions for the current billing cycle (if any), provide these receipts to their Authorizer,
and return the P-Card to the Procurement Office as part of the separation/clearance process, as outlined by Human Resources, prior
to separation from the University.
The Cardholder understands this program is a privilege and failure to follow the procedures contained in the P-Card handbook can
result in audit findings, which can result in a temporary revocation of use and even full revocation of this privilege.
The Cardholder must not allow any other individual, including co-workers, to use the P-Card or sign P-Card drafts under any
circumstances. The Cardholder can instruct co-workers to sign packing slips if a co-worker will be picking up items the Cardholder
has already ordered.
_______________________________________
Cardholder Signature Date
_______________________________________
Approving Official Date
_______________________________________
Procurement Coordinator Date