Fillable DCard Application Complete Department Custodian Information (Please Print) (Case Western Reserve University)

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DCard Application Complete Department Custodian Information (Please Print) (Case Western Reserve University)

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The DCard Application Complete Department Custodian Information (Please Print) (Case Western Reserve University) form is 2 pages long and contains:

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  • 7 check-boxes
  • 31 other fields

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U.S.A. forms for Case Western Reserve University

BROWSE CASE WESTERN RESERVE UNIVERSITY FORMS

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DCard Application
Page 1 of 2
Complete Department Custodian Information (Please Print)
___________________________________________ ______________________________________________________
Card Custodian Name (as shown on file with HR) Division / Department
______________ ___________________________ ______________________________________________________
EMPLID Password Building / Room/ Location Code or Mail Stop
______________ ___________________________ ______________________________________________________
Date of Birth Custodian’s Network ID Custodian’s Email address (first.last@case.edu)
___________________________________________ _____________________________________________________
Campus Telephone Number Default Speedtype (Must be an OPR)
DCard Guidelines for Use and Compliance
The DCard may only be used for departmental event support planning. The “Departmental” Card (DCard) will be assigned to the
appropriate person within the unit and will allow for food, retail and related purchases exclusively in support of department events.
Travel related expenses are not be permitted on these cards. DCards will be subject to frequent audit as well as increased controls
and reporting requirements.
The following are examples of actions that violate Dcard (and therefore DCard) policies and procedures and may result in
disciplinary action:
• Purchase of items for personal use
• Purchase of items defined in restrictions and limitations for the DCard
• Purchase of restricted items or services from merchants excluded from valid DCard merchant categories
• Use of the DCard for purchases of more than the single transaction limit established for your card by splitting the purchase
into more than one transaction
• Failure to return the DCard when reassigned, terminated or upon request
• Failure to obtain packing slips and receipts on every purchase and turning them in to your departmental administrator or
their designee for the purpose of establishing and maintaining files for accountable reconciliation procures
• Using the DCard for travel and entertainment items or services (Determined by Division or School)
Your monthly dollar limit coincides with the billing cycle which begins on the 26
th day of the month until the 25th day of the next
month. Accounts must be edited on-line on a 24-hour/7-day time period during the current activity cycle period. Account edits
must be made during current activity cycle no later than midnight (Eastern Time) of the 25
th day of each month.
Note:
Complete the following information if the Department Administrator or the designee will be editing your account.
All detailed original receipts must be reconciled with the statement information and retained in the department for audit
purposes for seven (7) years). All receipts must be reconciled with the statement information and retained in the
department for audit purposes.
_______________________________________ ______________________________________________________
Department Administrator Name (Print) Department Administrator Name (Signature)
_______________________________________ _______________________________________________________
Telephone Number Email Address
_______________________________________ _______________________________________________________
Department Administrator Name (Print) Department Administrator Name (Signature)
_______________________________________ _______________________________________________________
Telephone Number Email Address
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DCard Application
Page 2 of 2
Custodian Responsibilities
It is the cardholder’s responsibility to follow-up on any erroneous charges (disputes), returns or adjustments and to ensure proper
credit is given on subsequent statements.
• As an individual cardholder of the Case Dcard Program, I accept the responsibility for protection and proper use of the
Dcard as described and outlined in the Dcard program policies listed above and in the supplemental Dcard program user’s
guide.
• I understand that the university is liable to JP Morgan Chase for all charges I make using the Dcard. I understand that the
Dcard may be used only for authorized expenditures and no personal expenses will be charged to the card. In addition, I
understand that my Dcard or Dcard account number is not to be given to any other individual.
• I understand that the university may terminate my right to use the Dcard issued in my name at any time for any reason. I
agree to surrender the Dcard immediately upon request, upon transfer to another university department or upon
termination of employment.
• I understand that it is my responsibility to notify the program administrator by email with 24 hours of my employment
termination from the university. The notification email address is
caseDcard@case.edu. If Case’s program administrator
is not notified of my termination from the university, I will be personally responsible for all charges to the Dcard that are
initiated after my termination date.
• I am receiving the Dcard issued on behalf of Case Western Reserve University. I agree to accept responsibility for the
protection and proper use of this Dcard. I have read and understand, and agree to comply with all policies and procedures
governing the Dcard program. I understand that failure to do so may result in corrective action up to and including
termination of employment and/or possible criminal charges.
_______________________________ _____________________________________ ______________________________
Cardholder Name (Print) Cardholder Name (Signature) Date
As the Budget Director of the Management Center/Department, the required internal control structure and account
reconciliation procedures as outlined in the DCard policies and user’s guide are in place.
_______________________________ _____________________________________ _______________________________
Budget Director (Print) Budget Director (Signature) Date
As Dean, Chairperson, or Vice President I approve the issuance of the Case DCard to this individual.
_______________________________ ______________________________________ _______________________________
Name (Print) Name (Signature) Date
PROCESSING INFORMATION – OFFICE USE ONLY
□ Date Received _________________ □ Card Created _________________ □ Email _________________
□ Training _________________ □ Card Activated _________________ □ Card Deactivated _______________
□ Administrator Added____________ ______________________ __________________________
Logon ID Card number (3 digits)
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DCard Application Complete Department Custodian Information (Please Print) (Case Western Reserve University)

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Completed 18 August 2020

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