Purchasing Card Account Maintenance Form
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1Database
Approver
Purchasing Card Account Maintenance Form
Cardholder
Effective Date: _____________
Change for (name): _________________________________
Card Coordinator
Higher Level
DU email address: __________________________________
Please indicate requested change(s):
Name change: _____________________________
Higher level approver change:
New email address: _______________________
__________________________________________
Location change: ___________________________
List Affected Cardholders:
Phone number change: ______________________
Card coordinator change:
_________________________________________
**New coordinators must complete the
Card Coordinator Application
List Affected Cardholders:
FOAP change:
(Please list both the name and number)
From: ______ /______ /______ /______/_______
Div
Resp Ctr
Fund
Org
Acct
To: ______ /______ /______ /______/_______
Div
Resp Ctr
Fund
Org
Acct
** If you’ve changed departments please indicate your new
location and phone extension in the left hand column.
Grant fund change:
(Please check one)
Card cancelation:
Allow grant fund purchases
Reason:
Choose Reason
Disallow grant fund purchases
Card destroyed
Travel purchase permission change:
**Account closures are effective immediately. Card
(Check one)
Allow travel purchases
coordinator please shred card & call ext. 1-4107 to verify.
Disallow travel purchases
Higher level approver and budget officer signatures are
Card coordinator and cardholder signatures are required for
all changes (unless cardholder is no longer employed at DU)
required for all changes in the right-hand column
_____________________________________________
_____________________________________________
Budget Officer Signature and Date
Cardholder Signature and Date
_____________________________________________
_____________________________________________
Print Name
Print Name
_____________________________________________
_____________________________________________
Card Coordinator Signature and Date
Higher Level Approver Signature and Date
_____________________________________________
_____________________________________________
Print Name
Print Name
_____________ Axol | _____________ ListServ
Purchasing use only (initial and date):
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Parent category: Business