Purchasing Card Adjustment Request
This form is to be used in requesting any changes to a Purchasing Card. Changes must be clearly
stated below and the form must be completed (including all signatures) before it is to be
submitted to the Purchasing Card Coordinators.
Cardholder (print)
Department/Organization Date
Permanent Change Requested (select all that apply)
Change Per Transaction Limit to:
*Per transaction limit cannot exceed $2,000
Change Monthly Limit to:
Change FOAPAL/Account to:
*If a new card is needed with new department name on it, check here: ________
Allow “Closed” Vendors: ______
*Non-travel Meal request must be accompanied by a written justification and have
prior approval by both the Controller and the Director of Purchasing – see below
Other:
Temporary Change Request (select all that apply)
*Start Date: Date card can be Closed/Lowered:
Change Per Transaction Limit to:
Change Monthly Limit to:
Allow “Closed” Vendors:
* Justification must be provided for any adjustment request – either attach a written letter or use
the space on the back side of this form for purpose of this request.
Approval Signatures:
Account Manager Date
Purchasing Card Coordinator Date
For Non-travel Meal Authorizations (signatures required)
Purchasing Controller
click to sign
signature
click to edit
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