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PROCUREMENT CARD
CARDHOLDER APPLICATION |
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Cardholder Name: _____________________________________ Department: _________________
Social Security Number:
________________________________ Phone: ______________________
(Last 4 digits)
Email Address:
________________________________________
Procurement Card Default Cost Account Number:
_______________________
Additional Cost Accounts
(Operational Account required for contracts or grants
expenditures deemed unallowable):
_____________________
_____________________ Control Agent (C& G)
_____________________
_____________________ Signature:
____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Card Expiration
Monthly Spending Limit: _____________________________ Date
(C & G)_________________
Cardholder:
____________________________/_________________________/______________
Signature
Print Name Date
We, the undersigned, request the above individual be issued a Procurement Card based on the above information. In addition, we have read and agree to comply with the Procurement Card Administrative Directive.
Dean/Department Head: _________________________ /
_______________________/__________
Signature
Print Name
Supervisor/Control Agent: _________________________
/ ________________________/____________
Signature
Print Name
Pre-Audit (Business Office):
_________________________ / _________________________/_____________
Signature Print Name Date
Program Manager: ___________________________ /
________________________/___________
Signature
Print Name Date
Business Office Contracts and
Grants Approval (if applicable):
___________________________/________________________/____________
Signature
Print Name Date
_________________________________________________________________________________________
Central New Mexico Community College
Updated 6/06