Purchasing Card Template - Leon County Schools by cuiliqing


                                                                                                                      Revised 10/8/2010

                                            Purchasing Card Application
Issue a LCSB Purchasing Card for enter name of cardholder

Title enter job title of cardholder                                   Social Security # enter SS# of cardholder

Office Phone # enter phone # of cardholder                            Home Phone # enter home # of cardholder

Cost Center enter cardholder is assigned to                           Department enter facility/department

Single Purchase Limit enter daily NTE                                 Monthly Limit enter monthly NTE

Address for Billing:           Attn: Cost Center Account Clerk Name

                               Cost Center Street Address

                               City              State.          Zip Code

Principal/Cost Center Administrator Approval

Signature / Title                                                                          Date

To Be Used By Purchasing
Company Name as Appearing on Card: School District of Leon County School

Tax Identification Number: 47-04-025951-53C

Billing Cycle Date: Last day of each month

Merchant Category Code Blocks:

                                                   Building the Future Together
                    “The Leon County School District does not discriminate against any person on the basis of gender,
                        marital status, sexual orientation, race, religion, national origin, age, color or disability.”

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