PURCHASING CARD REQUEST FORM
Please Print Information
Name of Employee (as shown on driver’s license):_______________________________________
Last 4 digits of Social Security Number:
Cell Number: _________________________
Credit Limit: $_______________________ Department: _______________________________
This form must be signed by the parties indicated below and forwarded to the Director of
Purchasing and Compliance for processing. ( Allow 1 to 2 weeks for processing)
Employee:
________________________________ ____________________________
Signature Date
________________________________
Printed Name
Supervisor:
________________________________ _____________________________
Signature Date
________________________________
Printed Name
Chief Financial Officer:
________________________________ _____________________________
Signature Date
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