Appendix E. ATTACHMENT II: PURCHASING CARD ACCOUNT MAINTENANCE FORM

Type of Request (Circle One):

A. New Account E. Staff Relocation - New GL:

B. Address Change F. Temporary Increase, Amount:

C. Account Closure Reason:

D. Name Change Date:

G. Single Transaction Increase:

H. Other: Describe

To Add a New Account (Request "A"):

1. Circle "New Account under Type of Request Above"

2. Complete the section under "Card Information"

To Change Information on an Existing Account (all Other requests):

1. Indicate Type of Request Above

2. Fill in Last 8 Digits of Account Number:

3. Fill In Current Name on Card:

4. Complete only the Fields to be Changed in Card

Information Section:

Name (24 Characters) Embossed on Card Last 5 Digits of Card Holder's Number

Address (36 Characters Maximum) Job Title

City (25 Characters Maximum) Dept/GL Information

State (2 Characters) Zip Code

Authorization:

Employee Signature Date

Approving Director Signature Date

Program Administrator Signature Date

(Res. 2008-011, passed 2-19-2008)