not in use

UNLV Procurement Card Program Cardholder Account Application
New Card Application
Individual
Departmental
Change Request
Temporary Change
Change Effective Until
Cardholder Information
Cardholder Name (21 Characters): Or Department’ name
Required by Bank One for Cardholder Security
(This does not appear on a credit report)
Email Address:
Department:
LAST 4 DIGITS of Social Security # or UNLV ID Number:
Bldg.
Room #
Mail Sort:
Procurement Card Liaison (if different from Cardholder):
Date of Birth (MM/DD/YYYY):
Mother’s Maiden Name or Password:
The liaison will act on behalf of the Cardholder where record keeping and reconciliation are involved. This does not remove the
Cardholder from liability for an improper reconciliation.
Work Phone Number:
(702)
Credit Card Information
UNLV Account Numbers
Credit Limits
Fund (4)
Agency (3)
Org (4)
Sorg (Optional)
Monthly Credit Limit:
Primary Account:
If you are not a signature
authority on this account,
one of them must sign here:
(Maximum $10,000)
Single Purchase Limit:
X
(Maximum $5,000)
Fund (4)
Agency (3)
Org (4)
Sorg (Optional)
Dollars Per Day:
Backup Account:
If you are not a signature
authority on this account,
one of them must sign here:
(Optional)
Transactions Per Day:
X
(Maximum Ten)
Primary and Backup accounts are required to process this application.
However, you may use any account available to you for reconciliation.
Transactions Per Month:
(Maximum Sixty)
Hosting (Optional)
Fund (4)
Agency (3)
Org (4)
Sorg (Optional)
Host Account:
In order to receive pre-approval
for hosting, a Dean or Vice
President must sign here:
X
If this section is not signed by a Dean, or Vice President,
hosting will not be pre-approved. In this instance, each host
transaction will need to be reviewed and approved by the
appropriate authority in accordance with the PCard Policy
Application Authorization
This Application must be approved by a Department Chair, Director, Dean, or Vice President. It must also be accompanied by a completed
Cardholder Agreement. This form may not be self-endorsed.
By signing this form, you grant the applicant authority to obtain and use a PCard as outlined in the UNLV Purchasing Card Manual. The department
is responsible for approving all accounts used for transactions made against this card.
Recommended by:
(Please Print)
Approved by:
(Please Print)
Signature:
Date:
Signature:
Date:
(Cardholder’s supervisor)
(Dept. Chair / Director / Dean / Vice President)
DISBURSEMENTS USE ONLY
Reporting Hierarchy
Level Numbers
Level 2 (President/Vice)
Level 4 (Sub-Unit)
Level 5 (Fin Office)
- not in use -
Application Approved by:
(Please Print)
Level 3 (Division)
Signature:
(Program Administrator)
Appendix A – Cardholder Application and Agreement
Date:
UNLV Procurement Card Program Cardholder Agreement
The University of Nevada, Las Vegas is pleased to present you with the UNLV Procurement Card. It
represents the university’s confidence in you as a responsible employee of the university entrusted to
safeguard and protect university assets.
Cardholder Agreement:
I understand that all purchases are to be made for business use only and consistent with existing
policies.
The PCard program is not intended to avoid or bypass purchasing or payment procedures and is not for
personal use.
As a Cardholder, I agree to comply with the terms and conditions of this agreement and the stated provisions of
the Purchasing Card User Manual made available on the Purchasing PCard website. I attest that I will be
responsible for reviewing the online PCard Manual for updates and confirm that I have read and understand its
provisions. I understand that the university is liable to the issuing bank for all charges made by me.
As the holder of this PCard, I agree to accept responsibility for the protection and proper use of this card as
outlined in the agreement and the user manual. I understand that the university WILL review my use of this
PCard. I understand that I CAN NOT use the PCard for the purchase of services without written permission from
the PCard Program and that the purchase of such services shall be deemed an improper use of the PCard.
I further understand that improper or fraudulent use of this PCard may result in disciplinary action and/or
personal liability. Should I fail to use this PCard properly, I authorize the university to deduct from my salary, or
from any other amounts payable to me, an amount equal to the total of the improper purchases. I also agree to
allow the university to collect any amounts owed by me, even if I am no longer employed by the university. If the
university initiates legal proceedings to recover amounts owed by me under agreement, I agree to pay legal fees
or collection costs incurred by the university in such proceedings.
I understand that the university may terminate my right to use the PCard at any time for any reason. I agree to
return this card to the university immediately upon request or upon termination of employment.
Applicant Signature: _______________________________________________Date: ____________________
Printed Name: __________________________________________ Campus Phone #: ___________________
Department: _______________________ Mail Stop: ________ Email Address: _________________________
Department Approval:
As Department Chair/Director or Dean/Vice President, I approve the issuance of a PCard to this staff member and assume
overall responsibility for the card. I accept the responsibilities for this card as are outlined in the Purchasing Card User
Manual Section: Roles and Responsibilities -Department Head/Account Manager.
Recommended By:
____________________________________________
Supervisor
Approved by:
____________________________________________
(Dept. Chair / Director / Dean / Vice President)
For completion with card distribution
I hereby acknowledge receipt of the following procurement card:
Number: _____________________________________ Expiration Date: ___________________
Signature: ___________________________________________________ Date: _____________________
Appendix A – Cardholder Application and Agreement