Lock Haven University of PA

Purchasing Card Cardholder Enrollment Form

Required for each cardholder – Complete all designated sections and return to
Purchasing Card Administrator

CARDHOLDER

Card Type: _Purchasing___

Individual Transaction Dollar Limit:___$500______

Daily Maximum Number of Transactions:_5__ ______

Total Daily Spending Limit:____$2500_ ____

Monthly Dollar Credit Limit:__$10,000_____

Monthly Maximum Number of Transactions:____20_______

Cash Access:______No_____

V.I.P. Account:____No_______

LEVEL INFORMATION

(completed by Purchasing Card Administrator)

Level 1: Lock Haven University of PA

Level 2: Division________________________

Level 3: College________________________

Level 4: Department________________________

Level 5: Cardholder________________________

                Print last name, first name

                and middle initial

 


CARD STATEMENT

Lock Haven University Address

Building:_____________________________________________________________

                                                               

Cardholder Street Address:_______________________________________________

 

City:________________________ State:__________________ Zip: _____________


Home Address

Cardholder St. Address:_________________________________________________

 

City:___________________________ State:___________________ Zip:__________

 

Business Telephone:________________________ญญญญญญญญญญญญญญญญญญญญญญญญญญญ___________________________

 

Business Fax Number:_______________________________________________

 

Email address:_________________________________________________________

 

Home telephone:_______________________________________________________

 

Social security number:__________________________________________________

 

Mother’s maiden name:__________________________________________________

 

AUTHORIZATION/APPROVALS

 

Department Supervisor Name
(please print): _______________________________________________

 

Department/Supervisor Approval (signature):___________________________________________________________

 

Dean Approval (signature):___________________________________________________________

 

Purchasing Card Administrator Approval (signature):________________________________________________________