Purchasing Programs – Individual Card Applic ation
COMPANY / ORGANIZATION INFORMATION
THE UNIVERSITY OF AKRON
00007
Company / Organization Name*
APPLICANT SECTION -
Company Number*
* indicates a required field
1 APPLICANT INFORMATION
Full First Name*
Middle Initial
Last Name*
Date of Birth (MM/DD/yyyy)*
Country of Citizenship*
Tax Exempt 34-6002924
Name as it will appear on Card* (21 character limit)
Second line to appear on Card (21 character limit) e.g. department name, etc.
2 HOME ADDRESS
3 BUSINESS ADDRESS
Select Address
Street Address - no P.O. Box*
Street Address
Street Address Line 2 - if applicable*
Street Address Line 2 - if applicable
City*
City
Select City
OH
State*
M
Zip Code*
Country*
Deliver Card to Home Address only
4 ACCOUNT SECURITY
M
Deliver Statement to Home Address only
Other unique 4 digits
Select One:*
First 4 letters of your mother’s maiden name
Password 2*
Zip Code
Country
M Deliver Card to Business Address only M Deliver Statement to Business Address only
5 CONTACT INFORMATION
Select One:*
M Last 4 digits of Social Security Number
Password 1*
UNITED STATES
Select Zip
State
Primary Phone*
Select One:*
Secondary Phone
M Home M Business M Mobile
M Home M Business M Mobile
Select One:
@uakron.edu
Business Email Address
Other unique 4 digits and/or letters
ADMINISTRATOR SECTION - * indicates a required field
6 ACCOUNT TYPE
Select One:*
10 MERCHANT CATEGORY CODE GROUP SPEND LIMITS
Purchasing
Fleet
Indicate:*
Commercial
(One Card)
7 ACCOUNT FEATURES
MERCHANT CATEGORY
CODE GROUP *
E
040
$
Cash amount - Maximum
Card Design Code - Institution ID or
$2,500 and other organizational Agent ID
limits may apply
Declining Balance Purchasing/Commercial
Cards Only
Card Delivery Code - Site ID or
Special Handling Code
Rush Delivery Fee may apply
Non P.O. Box Address
Required for Delivery
POS Prompt Code - Fleet Only*
Spend Restriction - Fleet Only:
Fuel & Other (default)
Fuel Only
8 ACCOUNT SPEND LIMITS/CONTROLS
Cycle Spend Limit*
SINGLE
PuRCHASE
Include (I)
Exclude(E)
Max number of trans/cycle
CYCLE
SPEND
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
DAILY
TRANS
CYCLE
TRANS
8
8
Single Purchase Limit
Max number of trans/day
9 HIERARCHY
11 ADDITIONAL ACCOUNT INFORMATION
Do not complete unless instructed during program set-up
Level 1 - if applicable*
Level 2
Level 3
Employee/Student ID
Level 4
Level 5
Level 6
Accounting Code
Cost Center
12 ADMINISTRATOR CERTIFICATION - please read and sign
By submitting this request for commercial card issuance to the Bank for the applicant(s) named herein, the
undersigned, a duly authorized representative of the Client, does hereby (1) certify that, to the best of Client’s
knowledge, information and belief, the information in this application and the supporting documentation is
accurate, (2) certify that the true identity(ies) of the aforementioned applicant(s) has/have been verified and
that the applicant(s) is/are employee(s) or agent(s) of the Client and has/have been duly authorized to apply for
and use the Card(s) to incur expenses on behalf of the Client, (3) certify that the applicant(s) named herein have
consented to the provision of their information in this Application, and (4) confirm that the applicant(s) has/have
consented to the issuance of a Card(s) in their name(s). The Client shall maintain evidence of the applicant’s
consent to the provision of their information in this Application and the applicant’s consent to Card issuance and
shall furnish such evidence to the Bank upon request. In this application, the term “Bank” refers to JPMorgan
Chase Bank, N.A. and Chase Bank USA, N.A. and their affiliates.
Barbara
Fuller
Program Administrator / Approver Name Printed*
Use Today's Date
X
Program Administrator / Approver Signature*
Date
Program Administrator (Authorized Signer) Submit Application to:
Email: [email protected] Fax: 866-759-8590
US_PFI_P0513
THE UNIVERSITY OF AKRON
Procurement Card Application
Check if for Specialty Card – Declining Balance Card
Cardholder Information
First Name
Middle Initial
Last Name
Dept. Name
Employee ID#
UA Speedtype
Birth Date
Supervisor/Advisor Information
First Name
Middle Initial
Business Phone
Last Name
Email Address
(330) 972 -
Will you be going online to approve the cardholder’s transactions?
cardholder’s transaction below:
Yes
No
If NO, provide the name and email of the individual responsible for approving
@uakron.edu
@zips.uakron.edu
Approver’s Printed Name
Credit Limit Information
Credit Limit Requested
per month
per transaction ($1,500 maximum limit)
Terms & Conditions
The use of the University Procurement Card is limited to expenses authorized by the department and in accordance with University procedures. This credit card may be used for
the purchase of any approved item, in an amount less than $1,500.00 per transaction. There will be a monthly limit on this card. In the future if the limit needs to be changed,
please contact the Department of Purchasing.
The purchase of any items with this card that are listed as restricted per the Procurement Card Policy & Procedure Manual is prohibited. Any unauthorized purchase with the
University Procurement Card will be considered an unapproved transaction and the responsibility of the cardholder to reimburse the University. Violation or misuse of the
University Procurement Card may be construed as a theft of University funds and therefore turned over to the University Police for investigation and/or prosecution.
The using department acknowledges that it is responsible for all approved purchases charged against the University Procurement Card. The department also agrees that it will
establish an internal system of accountability to review all purchases made with the University Procurement Card and approve online all transactions that fall within the
guidelines, as established by the Procurement Card Policy & Procedures Manual and departmental policy. All original credit card receipts must be scanned and attached to
the online Paymentnet transaction file for payment and auditing purposes.
The cardholder is required to review and verify all transactions on-line on at least a monthly basis and report any discrepancies immediately to JP Morgan Chase and the
Department of Purchasing.
•
If the card is lost or stolen, it should be reported immediately to JP Morgan Chase at 1-800-270-7760 and the Department of Purchasing at 330-972-7340.
•
The using department must scan and attach receipts to the online Paymentnet transaction file for payment and auditing purposes.
I THE UNDERSIGNED, HAVE READ THE TERMS AND CONDITIONS ASSOCIATED WITH THE USE OF THE UNIVERSITY PROCUREMENT CARD AND
HEREBY ACKNOWLEDGE, DURING POSSESSION OF THIS CARD, ALL RESPONSIBILITY FOR USE UNTIL THE CARD IS RETURNED, OR REPORTED,
LOST OR STOLEN TO THE DEPARTMENT OF PURCHASING.
Applicant Signature
Date
Supervisor Signature
Date
Completed by Program Administrator
Hierarchy
MCC Code
Revised 4/10/14
Purchasing Approval