Fillable Pcardaccountmaintenencerequest

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Pcardaccountmaintenencerequest

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Cardholder Name: Date of Request:____________________________
Department Name:
Work Phone: ( )
GL Account Number: - - Credit Card Number ______________ (Last 4 Digits)
Check one: Permanent Change Temporary Change (Provide Start & End dates below)
FROM TO
GL Account Number: - - - -
Department:
Single Transaction Limit:
Monthly Credit Limit:
# of Daily Transactions
# of Mthly Transactions
Cardholder Name:
Other:
Temporary Change:
Start Date: End Date:
Cardholder Signature Date______________________
Dept. Head Signature Date______________________
Print Name
(if applicable)
Dean Signature
Date______________________
Print Name
Area V.P. Signature Date______________________
Print Name
Program Coordinator Date______________________
Print name
Approving Individual Date______________________
Print name
Approving Individual Date______________________
Print name
Updated January 2016
Phone: x5391 Fax: (732)923-4652
Account Maintenance Request
Purchasing Card
For Controller's Office Use Only
Please return completed and approved request to the Program Coordinator
Loretta Dickerson, Controller’s Office
Loretta Dickerson
Mary Byrne
Elizabeth E. Lunney
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Pcardaccountmaintenencerequest

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Completed 14 March 2020

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