PCard Account Maintenance Form
Please indicate type of PCard: Individual Department
Card Information:
Name on Card: _______________________________________________________________
Bank of America Account Number (last 4 digits): XXXX - ________________
Place a check next to each requested change(s):
Increase/Decrease monthly credit limit from $ ___________________________ to $ ___________________________
If an increase, write a brief email justification attached with this form.
Department Card – If your department requests a monthly limit of over $1000 you must have your Vice
President’s or Dean’s signature on this Maintenance Form.
Vice President or Dean’s Signature/Date X:_____________________________________________________________________
Increase/Decrease single transaction limit from $ ________________________ to $ ______________________________
Increase/Decrease daily transaction limit from $ _________________________ to $ ______________________________
If an increase, write a brief email justification attached with this form.
Change Card Name to: _____________________________________________________________________________________________
(As it will appear on card, including middle initial (only for individual) maximum 24 characters.)
Change Card manager
From: ___________________________________________________ To: ____________________________________________________
Change Card Approver
From: ___________________________________________________ To: ____________________________________________________
Change Card Reconciler
From: ___________________________________________________ To: ____________________________________________________
Change Email address from: __________________________________ To: ____________________________________________________
Individuals Changing Departments from: ____________________________________ To: ____________________________________
** Complete a “Cardholder Application” along with this form, submitting them together – card number will remain the same **
Issue card replacement due to: lost card stolen card not received
(check one) embossing error damaged other ____________________________________
Account Closure/Cancellation (effective immediately)
Reason: ________________________________________________________________________________________________________________________
(retiring, card no longer needed, no longer ISU employee, changing positions within ISU)
I certify that no unauthorized purchases that could be considered misappropriation of State funds have been made by
myself or anyone known to me as of _____________________________________ (date card was last used)
X_________________________________________________________________ X________________________________________________________________
Cardholder Signature/Date Supervisor Signature/Date
For Purchasing Only
Agency Purchasing Card Administrator Signature/Date X: ____________________________________________________________________________
Processed By/Date:______________________________________________________________________________________________________________________
