Procurement Card Application - Financial Services
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3Procurement Card Application
(Updated 6/19/2014)
All information is required to effectively screen against sanctions lists, in order to comply with legal obligations to
the U.S. Office of Foreign Assets Control.
Full Legal Name:
EMPL ID:
Date of Birth (mm/dd/yy):
Country of Citizenship:
Mother’s Maiden Name:
Email address:
University Phone Number:
Other Phone (optional):
Cardholder Campus Address (please include box number):
Danforth
Med. School
West Campus
Other
Campus Box
Campus Box
Campus Box
Campus Box
1 BROOKINGS DR
660 S EUCLID AVE
7425 FORSYTH BLVD
ST LOUIS, MO 63130
ST LOUIS, MO 63110
CLAYTON, MO 63105
Cardholder Home Address:
Transaction Limits:
Standard Single Transaction Limit $1,500 or Optional Higher Limit
Standard Monthly Credit Limit $5,000 or Optional Higher Limit
Transaction Default Account for AIS (auto-approved RP documents will be charged to the default account):
Account
Account
Account
Account
Account
SR
Dept.
Ledger
Class
Fund
Budget
Object
Code
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2
Primary Transaction Reviewer (please print)
Primary Transaction Approver (please print)
Name:
Name:
Email:
Email:
Approvals
I have read and agree to comply with the policy and procedures in the Procurement Card Program Guide and I agree to attend all
required procurement card training. I further understand that failure to comply may result in grounds for immediate dismissal and may
also result in referral for civil or criminal legal action. Should my affiliation with the University change or terminate, these
prohibitions remain in effect.
Applicant’s Signature: ________________________________________
Date: ________________________
Management Approval:
I understand the functions of the user role(s) being provided and authorize the access to the individual listed above.
Printed Name: ___________________________________
Title: _______________________________________
Signature: ______________________________________
Date: _______________________________________
Please send completed application form to: Card Programs Administrator, Campus Box 1147
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Parent category: Business