PCard Application
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Complete Cardholder Information (Please Print)
___________________________________________ ______________________________________________________
Cardholder Name (as shown on file with HR) Division / Department
Last Name, First Name
______________ ___________________________ _____________________________________________________
EMPLID Mother maiden name/Password Building / Room/ Location Code or Mail Stop
______________ ___________________________ ______________________________________________________
Date of Birth Network ID Email address (first.last@case.edu)
___________________________________________ _____________________________________________________
Campus Telephone Number Default Speedtype (Must be an OPR)
Select Credit Limits
Check only one in each column
Single Transaction Limit Monthly Limit
$1,500 □ $5,000
$3,000 □ $10,000
$4,999 □ $20,000
Cardholders Guidelines for Use and Compliance
The PCard may only be used for Case business. The PCard program administrator will assign your maximum single
transaction limit and your monthly dollar limit as specified by the Case cardholder granting department and by the Case
policies established for use of this card. This statement applies to any authorized single transaction limit that is established
for the benefit of the cardholder by a Case authorizing representative.
The following are examples of actions that violate PCard policies and procedures and may result in disciplinary action:
Purchase of items for personal use
Purchase of items defined in restrictions and limitations
Purchase of restricted items or services from merchants excluded from valid PCard merchant categories
Use of the PCard 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 PCard 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
Allowing another individual use of your card or providing your PCard account number to another individual for
their use
Using the PCard 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
day of the month until the 25
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
day of each
PCard Application
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All receipts must be reconciled with the statement information and retained in the department for audit purposes.
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 PCard Program, I accept the responsibility for protection and proper use of
the PCard as described and outlined in the PCard program policies listed above and in the supplemental PCard
program user’s guide.
I understand that the university is liable to JP Morgan Chase for all charges I make using the PCard. I understand
that the PCard may be used only for authorized expenditures and no personal expenses will be charged to the card.
In addition, I understand that my PCard or PCard account number is not to be given to any other individual.
I understand that the university may terminate my right to use the PCard issued in my name at any time for any
reason. I agree to surrender the PCard 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
casePCard@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 PCard that are initiated after my termination date.
I am receiving the PCard issued on behalf of Case Western Reserve University. I agree to accept responsibility for
the protection and proper use of this PCard. I have read and understand, and agree to comply with all policies and
procedures governing the PCard 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
Note: Complete the following information if the Department Administrator or the designee will be editing your
Department Administrator Name (Print) Department Administrator Name (Signature)
_______________________________________ _______________________________________________________
Telephone Number Email Address
Read and completed all signatures
As the Budget Director of the Management Center/Department, I agree to adhere to the required internal control
structure and account reconciliation procedures as outlined in the PCard policies and user’s guide are in place.
____________________________ _____________________________________ ___________________________
Approver (print) Approver (Signature) Date
_______________________________ _____________________________________ ___________________________
Budget Director (Print) Budget Director (Signature) Date
As Dean, Chairperson, or Vice President I approve the issuance of the Case PCard to this individual.
_______________________________ ______________________________________ ___________________________
Name (Print) Name (Signature) Date
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PCard Application
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Hierarchy Levels
Date Received _________________ Card Created _________________ Email ________________
Training _________________ Card Activated _________________ Card Deactivated_______________
Administrator Added____________
______________________ ______________________
Logon ID Card number (3 digits)