SAM’S CLUB DIRECT MEMBER PROGRAM
Davis School District
PROGRAM INFORMATION & CARD REQUEST
Revised 8/4/09
Read the following information, the User Agreement and complete the Card Request form. Fax (page 2 only AND a purchase
order to cover the initial annual membership fee of $15.96 per card) to the: Director of Purchasing - 402-7809. DO NOT fax or
mail to Sam’s Club. Unsigned requests will be rejected and returned. After faxing, cardholder retains original for reference.
CARDS ARE ISSUED BY THE PURCHASING DEPARTMENT through the District’s Pony service.
The Direct Member program facilitates the purchase of materials and supplies from Sam’s Club stores. Use of the card, in
conjunction with a District purchase order, eliminates the need for employees to make business purchases with personal funds
and, therefore, the necessity of submitting claims for employee reimbursement. This program is the only authorized means for
charging transactions directly to the District.
Program Information
Card entitles the cardholder, upon verification of identity, and up to two (2) accompanied guests to access any Sam’s
Club store.
Card authorizes only the designated cardholder to make approved transactions on behalf of the District up to the
maximum dollar amount shown on the official purchase order issued by the District.
Cards are NOT transferrable. Cards cannot be issue in the name of the location for use by multiple personnel.
Cardholder shall make business-related transactions ONLY on behalf of the District.
Annual card cost is $15.96. A purchase order must be generated and included with the initial card request. Each
year thereafter, a purchase order must also be generated to pay the annual membership renewal fee. Purchase
orders generated for membership fee payments are internal documents only and are NOT to be mailed or provided
to Sam’ Club.
Locations may wish to consider establishing a blanket purchase order in Encore from which new membership and
renewal fees can be charged. The same blanket purchase order could be utilized for anticipated merchandise
purchases. Blanket purchase orders are valid for one fiscal year only.
Cards issued are automatically renewed annually.
Cardholder & Location Responsibilities
Cardholder presents the Direct Member card AND a purchase order for merchandise to the cashier upon checkout.
Purchase order is limited to a total “not-to-exceed amount” of $999.99 unless competitive quotes have previously
been obtained and retained on file for audit purposes. The purchase order shall show a: quantity of “1”, unit of issue
of “order of”, description of “Misc. items not to exceed $xxx.xx”, unit price of “$xxx.xx” (same as not-to-exceed
amount). If a blanket purchase order is established, the not-to-exceed amount is the amount anticipated to be spent
during the entire fiscal year including membership and membership renewal fees.
Cardholder declares to cashier that transaction is Utah sales tax exempt: 11843690-022-STC.
Cardholder submits sales receipt to location budget manager or designee who retains documentation in accordance
with District Finance, Audit and Purchasing policies and procedures.
Location verifies receipt of items and quantities as designated on the sales receipt and makes a receiving entry in the
Encore system against the purchase order.
Cardholder retains possession of the card, if transferring to a different location, and notifies the Purchasing Dept.
(x27802) to update records.
Cardholder notifies Sam’s Club and the Purchasing Dept. if card is ever lost, stolen or damaged. Contact the
Purchasing Dept. if budget manager no longer desires the employee to possess or use the card.
Cardholder notifies Sam’s Club to dispute any unauthorized transactions and works with the District’s Accounting
Dept. to ensure proper credit is issued.
Page 1 of 2
_____________ _____ ________________
Cardholder FIRST Name
Int.
Surname
SAM’S CLUB DIRECT MEMBER CARD REQUEST & USER AGREEMENT
By signing below, the intended cardholder acknowledges having received, read and understood the Program Information and
Cardholder Responsibilities as identified on page 1. Further, the cardholder agrees to and accepts the User Agreement and
associated terms and conditions as outlined below. In consideration for receiving the privilege to use the Sam’s Club Direct
Member card, the cardholder hereby agrees to and accepts the following:
The Direct Member card (card) is the property of Sam’s Club (Sam’s). Sam’s or the District may revoke, seize,
terminate or suspend the card or use thereof at any time and for any reason deemed appropriate by either Sam’s or
the District. Cardholder agrees to promptly surrender the card upon request by agents of Sam’s or the District.
The card shall be used for District business purposes only. Personal use is expressly prohibited. Intentional
unauthorized use by the cardholder is subject to District disciplinary action up to and including termination of
employment. The cardholder may also be subjected to legal action to recover assets, or the monetary equivalent, of
any unauthorized transaction(s) and be subjected to appropriate criminal and/or civil penalties.
Cardholder expressly grants the District the right to deduct from his/her payroll the value of any intentional
unauthorized purchases made by the cardholder.
Upon termination of employment, the cardholder shall promptly surrender the card to his/her immediate supervisor
and notify the Purchasing Dept. accordingly.
The cardholder agrees to comply with all District policies and procedures governing the use of the card. Specifically,
but not necessarily limited to, the policies & procedures governing the authorization and encumbrance of funds,
documentation retention and procurement activities.
The cardholder agrees to safeguard the card. In the event the card is lost or stolen, the cardholder agrees to
immediately notify Sam’s and the Purchasing Dept., and to report any unauthorized purchases.
The cardholder understands that the card cannot be used by, loaned or transferred to any person or District
employee.
In the event the cardholder transfers to another District location, the cardholder may retain the card for future use in
his/her new assignment provided the new budget manager agrees to its retention and use; otherwise, the card shall
be surrendered to the new budget manager. In either event, the Purchasing Dept. shall be notified of the card
transfer or intent to terminate.
__________________________________________
_______________________
Cardholder Title or Position
Location Name
________________________________________________________
Cardholder Signature
_______________________________
Date
The undersigned requests the issuance of a Sam’s Club Direct Member card for the above employee and agrees to
enforce the terms and conditions of the User Agreement, ensure the program operates as intended and to promptly
notify the Purchasing Dept. of personnel actions that may affect the use of this card at my location.
________________________________________________________
Principal/Director Name (please print)
_______________________________
Date
_____________________________________________________
Principal/Director Signature Approval
_______________________________
Location Number (3-digit)
FAX THIS PAGE ONLY & A PURCHASE ORDER FOR MEMBERSHIP FEE TO:
ATTN: DIRECTOR OF PURCHASING
402-7809
Page 2 of 2