Purchasing PC02
Purchasing Card (PCard) Change Request Form
This form is used by Purchasing Cardholders to request a change in their Purchasing Card balance limit, individual
transaction limit, to remove or add MCC code restrictions, and to cancel the card should they no longer need it.
Cardholder Information:
Full Name: ______________________________________________________________
Last 4 digits of PCard # ______________
Cardholder Change Request:
Date of Request: ________________
Current Single Transaction Limit: $2,825.00
Current Single Transaction Limit Request: _____________
Current Monthly Limit: $10,000
Requested Monthly Limit: _______________
Explanation for the Increase: ___________________________________________________________
___________________________________________________________
MCC Groups lift Restrictions: Check appropriate box and provide reason
Hotels ☐ Travel ☐ Meals ☐ Auto Rent ☐ Gas
Explanation for the lift of MCC Restriction: _________________________________________________
_________________________________________________
Is this above request a permanent request or a temporary Request? ____ Permanent _____ Temporary
If the request is permanent, please explain why: ________________________________________
Cancelling a Purchasing Card:
Request to Cancel PCard? Yes ☐ No ☐
Pcard receipts and statements are kept with Office Administrator for Auditors: ☐ Yes ☐ No
Purchasing Card Change Request Approval:
Your approval of the form and confirms that all information is accurate. Approval must either be with written signature of official
digital signature.
Card Holder: ________________________________________________ Date: _______________
Department Head/Dean: ______________________________________ Date: _______________
Procurement Office Approval:
Purchasing Card Administrator: ________________________________ Date: _______________
Procurement Manager: _______________________________________ Date: _______________
Administrator Notes: ___________________________________________________________________
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