Purchasing Card Request Form

St. Lawrence University
Department Purchasing Credit Card Request Form

PLEASE RETURN TO THE PURCHASING OFFICE


____________________________________    OR   ___________________________________
Name                                                                            Department

(If card is to be issued in the name of an employee)                       (If card is to be issued in the name of a department)

€       Faculty                     €       Staff

Work Phone #: _______________________           Cell Phone #: _______________________

Date of Birth: ________________________           Employee Saints ID#:_________________

                                                                                     (as shown on SLU identification card)
Email Address:___________________________

Employee Who Will Be Authorizing Transactions On-line: ___________________________


Cost Center Expenses will be charged to:  ___ - ______ - ______ - _____________ - _______

All information needs to be filled out to prevent a delay in processing the card.

I request a Corporate Card for Purchasing issued under St .Lawrence University’s agreement with M&T Bank.  I have read the Cardholder Agreement form attached and agree to comply with the terms and conditions as set out therein.  I understand that the card will be revoked if I fail to comply.



Cardholder Name (printed): ______________________________________________________

Cardholder Signature: __________________________________________      Date: _________


VP or Dean or Chair Signature: ___________________________________     Date: _________
 

PLEASE RETURN TO THE PURCHASING OFFICE

For Internal Use:

€       Create New Account

€       Set Card Owner

€       Set Allocation Code

       Send Account Creation Email

       Send Card Has Arrived Email

Initials: _______________ Date:_____________