PROCUREMENT CARD MAINTENANCE FORM (Please print or type information) Agency Name:
Valencia College
Cardholder Name: ________________________________________________________________________________ Cardholder’s phone extension: ________________________Department ____________________________________ Cardholder Name Change Name as it currently appears: ________________________________________________________________________ Name as it should appear: __________________________________________________________________________ Signature of new name: ____________________________________________________________________________
Account Cancellation For lost or stolen cards, please contact JPMorgan Chase at 1-800-270-7760 anytime Lost/Stolen_________
Employee Resigned__________
No Longer needed__________ Suspected Fraud ____________
Other: __________________________________________________________________________________________ Any Lost/Stolen or Suspected Fraud cards are subject to a written Security Report. No new cards will be issued without a Security Report. Credit Line Change Single Transaction:
FROM $__________________ TO $________________ Reset __________________
Monthly Limit:
FROM $__________________ TO $________________ Reset __________________
Length of time needed: (Up to three months) ___________________________________________________________ Justification: ______________________________________________________________________________________
The Cardholder, Budget Manager & PCard Administrator must sign this form prior to processing.
Cardholder Signature: _______________________________________________________________ Date: ______________
Budget Manager’s Name: (print) ______________________________________________________ Date: ______________ Budget Manager’s Signature: __________________________________________________________ Date: ______________
Approval if Cardholder & Budget Manager are the same: ___________________________________ Date: ______________ (Direct Supervisor)
Forward this Maintenance Form to: Procurement, Attn: PCard Administrator, MC 4-42, Fax 1209
Procurement Office Use only PCard Administrator’s signature ___________________________________________________________ Date changes made ________________________
Form Version 1.6
updated 11/2011
Valencia College