University of Arizona Purchasing Card Account Form

The University of Arizona
Departmental PCard Responsible Cardholder Transfer Form
 

Appendix F - 02/05

Instructions:
  1. Complete the form. TAB to access each field.
  2. Press the "Submit" button located at the bottom.
  3. Print the application that is provided.
  4. Obtain required signatures (Responsible Employee, Liaison, Department Head)
  5. Send to Misty McCormick, Purchasing Card Coordinator, Procurement & Contracting Services, USA Bldg 300A.
MasterCard Number   - - -

Responsible Cardholder Information


NEW Responsible Employee  Name
(24 Characters)		 CURRENT Responsible Employee  Name
(24 Characters)
Department Name as appears on PCard
(24 Characters)		 Department Number
(4 or 5 Characters)

  The following pieces of information will be sent in an encrypted email message. They will not appear on the form that will be mailed to the System Coordinator. The System Coordinator will decrypt them, enter them on the form for use by JPMorgan Chase in issuing the Purchasing Card, and save the message as encrypted. This is done for the protection of our employees credit status and records.
NEW Employee EID # -- NEW Employee Activation Password 
(10 characters)

Reconciler and Approver Information

The reconciler and approver EID's and email's will be sent in an encrypted email message. They will not appear on the form that will be mailed to the System Coordinator.
Reconciler:
Name EID  - - UA NET ID
E-mail: 
Send Email Notification for Pending Transactions to reconciler?  Yes   No
Approver:
Name EID - - UA NET ID
E-mail: 
Send Email Notification for Pending Transactions to approver?  Yes   No