Montana State University Purchasing Card
Individual Card Application & Maintenance Form
Please print clearly and completely. Incomplete applications cannot be processed.
Cardholder’s Name (Last, First, Middle Initial,)
Employee ID Number (GID)
0-__ __ __ __ __ __ __ __
Opt In (To Receive E-Mail Notification of charges)
___ Cardholder
___ Account Manager
___ Business Manager
Campus Address P O Box (For Statement Delivery)
Default Account Number
(Index)
Campus Phone (Area Code, Phone Number)
*Required
Responsible Organization Number
Banner Department Name:
Departmental Account Manager:
Back-up Departmental Account Manager:
________________________________________________
Signature Date Signed
________________________________________________
Signature Date Signed
________________________________________________
Department Head’s Signature Date Signed
Cycle Spending Limits
$_____________________
($25,000 Recommended)
Single Purchase Limit
$______________________
($3,000 Recommended)
MCC Table
___ Company Default MCC Table
___ Travel Package Only
Mode of travel, hotel, car rental
Plastic Layout
Please Print Campus Location: _________________MSU-Billings ,
(This will print on card under cardholder’s name)
Agreement
I acknowledge that I have read and understand the Purchasing Card Manual and will follow all
requirements. Non-adherence to any of the procedures outlined in the manual will result in revocation of
individual cardholder privileges and may result in revocation of all departmental credit cards. I understand that
my use of the University’s credit card for personal purposes or by loaning my University credit card to an
unauthorized individual will result in discipline, up to and including dismissal from employment. I hereby
authorize the University to hold my final paycheck until I have returned the credit card to my supervisor. I also
authorize the University to withhold from my paycheck any amounts charged to me for any personal or non-
reimbursable use.
Applicant’s Signature _________________________________________________Date__________________
Office Phone Number and Fax Number:
PH: (406) 994-5727
FX: (406) 994-1954
Program Administrator’s Signature___________________________________________Date___________________
