Virtual Credit Card (VCard) Enrollment Form
What is a virtual credit card (Vcard)?
General Information
Merchant Name Merchant Code (A Number)
Taxpayer ID
Contact Information
CC Email Address(es) - Email will be copied on any communications sent to the email(s) above
Phone Number Form Submitter Name
Address Form Submitter Signature
City, State, Zip Date
Internal Use Only: VCard Setup (Pull method/Enable single-use accounts)
GXADIRD Setup (RT - 000000000, AT - 123456789)
*A Numbers can be found on purchase orders;
top left following the words "Vendor Number")
*New vendors leave blank
The virtual credit card payment option offers vendors the ability to be securely paid through a one-time use
credit card. Vendors will receive an email remittance advice which contains a link to access the credit card
information. Vendors will process the credit card transaction through their normal credit card processor.
Email Address(es) - Email will receive payment remittance with credit card link. Email will be used as contact for
any payment related questions.
Complete, sign and date. Submit this form via email to
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