Fillable Pcard App (University of Dayton)

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Pcard App (University of Dayton)

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RETURN FORM TO: Procurement and Payable Services, 300 College Park, Curran Place M2518, Dayton, OH 45469-7023
Purchasing Card/Declining Balance Application
Cardholder Information:
Card Type: ☐ Purchasing Card
☐
Declining Balance
Cardholder Legal Name:
(First, Middle Initial, Last – Limit to 21 Characters)
First 10 Letters of Mother’s
Maiden Name or Security Word:
Date of Birth:
Home Address: (Street Address, City, State, Zip)
Employee ID:
Email:
Personal Phone:
Job Title:
Department:
Office Phone:
Declining Balance Limits:
Department FOAPAL String:
Single Purchase Limits
Monthly Limits
Initial $ Value:
Fund:
☐
$1,500 Limit
☐
$5,000 Limit
Organization:
☐
$2,499 Limit
☐
$10,000 Limit
Single Purchase Limit:
Program:
☐
$4,999 Limit
☐
$20,000 Limit
Activity:
*A purchase above your limit(s) should be procured with a Runway purchase
order (PO). Please plan accordingly.
Location:
Limits requested above those offered herein will require additional justification outlining the historical and future
need for the limit and are subject to Finance approval.
1. I understand that the University is liable to JP Morgan Chase for all charges that I make using the PCard.
2. I understand that the PCard may only be used for authorized University purchases and that personal expenses on the PCard
are strictly prohibited.
3. I understand that it is my responsibility to notify the program administrator in writing within 24 hours of my employment
termination from the University at pcardreview@udayton.edu. If the program administrator is not notified, I understand
that I may be held personally responsible for any charges to the PCard that are initiated after my termination date.
4. I have read and understand the University of Dayton PCard Rules and Procedures and agree to follow the established
guidelines when using my PCard.
5. I have read and understand University of Dayton Travel Policy and agree to follow the established guidelines.
6. I understand that the University of Dayton can terminate my right to use the PCard at any time, for any reason.
7. I understand that I am the only individual authorized to use the card assigned to me. It is not transferable to any other
individual.
8. I understand that I cannot use the card to purchase any item on the Unauthorized Purchases list nor may I use the PCard for
ANY personal purchases.
9. I understand that failure to comply with the University of Dayton policies and procedures will result in revocation of my
user privileges or other disciplinary or legal actions, up to and including termination of employment.
10. I agree that should I violate the above terms, I will be liable for the charges.
Required Signatures:
Cardholder Signature
Print Cardholder Name
Date
Supervisor Signature
Print Supervisor Name
Date
Budget Manager Signature
Print Budget Manager Name
Date
Purchasing Card Administration Use Only:
Type of Card Ordered:
☐
Purchasing Card
☐
Declining Balance Card
Program Administrator Signature
Print Program Administrator Name
Date
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Pcard App (University of Dayton)

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Completed 21 July 2020

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