PROCUREMENT CARD APPLICATION
________________________________________________________________________
Last
Name First Name Middle Initial
5151 State University Dr.
Los Angeles CA 90032-4226
City State Zip
( )
Department Building Room# Business Phone
Email Address Employee ID__________________________
California State University, Los Angeles
5151 State University Dr., ADM-514
Company Address
Los Angeles CA 90032 City
State Zip
Monthly Credit Limit Single Transaction Limit
Name of Approving Official-PRINT Name of Alternate Approving Official-PRINT
CHARTFIELD_______________________________________________________________________
Signature of Applicant / Date Signature of Approving Official / Date Signature of Alternate Approving Official /Date
* PLEASE RETURN TO OFFICE OF PROCUREMENT AND CONTRACTS, ADM-501. PLEASE CONTACT 323/343-3487
MARINA JAUREGUI, PROGRAM ADMINISTRATOR, IF YOU HAVE QUESTIONS. YOUR CARD SHOULD ARRIVE
WITHIN 5 BUSINESS DAYS, AT WHICH TIME YOU WILL BE CONTACTED.
(Rev. 03/15)
EMPLOYEE INFORMATION
COMPANY INFORMATION
EMPLOYEE / ALTERNATE/APPROVAL SIGNATURE
ESM-Eprocurement Access