University of Arizona Purchasing Card Account Form

The University of Arizona
  Purchasing Card Change Form
 

Appendix E - 05/03

Instructions:
  1. Complete the form to change address, reconciler, approver or card limits.  TAB to access each field.
  2. Press the "Submit" button located at the bottom.
  3. Print the form that is provided.
  4. Obtain required signatures (Liaison)
  5. Send to Purchasing Card Coordinator, Procurement & Contracting Services, USA Bldg 300A.

Change (Complete ONLY the fields to be changed)  - - -

 Individual Visa      Departmental Master Card Card Type
 Add      Remove Allow Airline / Transportation for employee travel?
Cardholder Information


Cardholder Name or
Responsible Employee Name
(24 Characters)		 College Name
(30 Characters)
Department Name or
Department Card Name
(24 Characters)		 Department Number
(4 or 5 Characters)

The Campus Address will determine where the cardholder's statements are mailed. If they are to go to a central location in your unit, use that location for the Campus Address for every cardholder. Be sure to inform each cardholder what Campus Address has been used on their application form. It is that address that they should give to merchants if asked for their billing address. Giving any other address will result in a declined transaction.
 
Campus PO BOX;
(7 Characters)		 Work Phone: ()-
Campus Street Address
(25 Characters)		 City
(23 Characters)
State Zip Code -

Fill in Reconciler and Approver Information

Reconciler:
Name EID  - - UA NET ID
E-mail: 
Approver:
Name EID - - UA NET ID
E-mail: 

Cardholder Controls


Single Purchase Limit:
(Must be $5,000 or less)		 $ Purchases per month
Credit limit:		 $
Number of Transactions per Day: Number of Transactions per Month: