Purchasing Card Application
FRD : 5/2/2018
FOR USE BY ACCOUNTS PAYABLE OFFICE ONLY
SEND COMPLETED FORM TO: purchasingcard@semo.edu
Last Name:MI:
Job Title:
Department:
Work Phone:
Email:
Card Default Index Code:
APPLICANT SIGNATURE: DATE:
Justification for Other Limit:
REQUEST INITIAL CREDIT LIMITS
Standard - $5,000 Monthly / $5,000 Per Transaction
Other -
Monthly Limit: $
SUPERVISOR INFORMATION
Supervisor Name: Southeast ID:
I AGREE TO THE FOLLOWING REGARDING MY ROLE IN THE PURCHASING CARD PROGRAM AT SOUTHEAST MISSOURI STATE
UNIVERSITY.
I have read and understand the Purchasing Card Manual.
I agree to review and approve transactions within the required deadlines, to approve reports on a regular basis, and to
ensure that all applicable back-up documentation is maintained.
I agree to not approve transactions that do not correspond with the program policies and to notify Accounts Payable
of these discrepancies or violations immediately.
I understand my responsibilities as they relate to the Purchasing Card Program and authorize the above request.
DATE:SUPERVISOR SIGNATURE:
Application Approved by: Date:
Additional Notes:
App Received Date:
Training Completed:Card Ordered: Card to Applicant:
First Name:
Southeast ID:
Work Phone: Email:
FCD : 11/1/2013
CARDHOLDER INFORMATION
