ARKANSAS TECH UNIVERSITY P-CARD CANCELLATION
Completed form may be faxed to
Date: ___________________ 479-968-0633
To: Purchasing Department
From: Cardholder Name: _____________________________________
Department Name: _____________________________________
Cardholder Phone No: _____________________________________
Last 4 digits of Card No: _______________
My Procurement Card is to be cancelled for the following reason (
PLEASE CHECK ONE)
Change of Name
Change of Department/Account Number
Termination of Employment
Other. Please explain.
Cardholder’s Signature: ____________________________________
Signature of Immediate Supervisor: ____________________________________
FOR USE BY PURCHASING DEPARTMENT
Date Notified: _______________ Time Notified: __________ Initials: ___________
Name of VISA Employee: ___________________________________________
(1-800-VISA911)
Name of U S BANK Employee: ___________________________________________
(1-800-344-5696)
