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SANTA CLARA UNIVERSITY PURCHASIN

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									SANTA CLARA UNIVERSITY PURCHASING CARD APPLICATION
This Application Should Be Returned To The Purchasing Department. Shaded Areas Are To Be Completed by Applicant. Name of Card Holder: Campus Location/Building:

Last 4 digits of SS#: E-Mail Address of Card Holder: Additional 25 Characters of Description Below Name: Campus Phone Number: Campus Mailing Address: Santa Clara, CA 95053-__ __ __ __ (Department Zip+4) Requested Credit Limit: (See Procedures for Options)
TEMPLATE # $ LIMIT PER TRANSACTION $ PER BILING CYCLE

ACCOUNT PROGRAM

FUND ACTIVITY

DEPARTMENT CLASS

NOTE: If the fund number is between 41001-46500, the completed form must be routed through the University Finance Office for fund approval prior to returning to the Purchasing department for card issuance. The cardholder agrees upon the following terms and conditions for this Purchasing card.  I have completed a Purchasing Card training session and agree to the terms and conditions of Santa Clara University’s Purchasing Card Program.  I understand that the card is to be used by the cardholder only.  I understand that the cardholder is responsible for reconciling all monthly purchases. Any purchase dispute and/or reconciliation problem is between the cardholder and the supplier and/or Bank of America. If the cardholder does not resolve these disputes by the payment cut-off date, I understand that the above accounting distribution will be charged.  I understand that I am responsible for retaining all original receipts for three years to comply with audit requirements.  I understand that all transactions must be for the use and benefit of SCU. No personal purchases are allowed under any circumstances.  I understand that the Purchasing Card cannot be used for the following items: Alcohol Entertainment expenses Postage Business Cards Food, Beverages & Catering Printing Cash Advances Leases Sponsored Project Purchases (Fund 13001) Construction/Renovations Meals in Restaurants Travel, travel related expenses Consulting Services Personal Items and Purchases Contract Maintenance Photocopiers  I understand that the cardholder is responsible for securing budget manager authorization for the requested credit limit.  I understand that non-adherence to any of the terms and conditions of the Purchasing Card agreement will result in revocation of individual cardholder privileges and that my department is responsible for all unpaid balances.  I understand that fraudulent use of the card will be subject to disciplinary action up to and including termination. Should my employment with Santa Clara University cease for any reason, I agree to return the card to Human Resources in my exit interview. Signature _______________________________________________Date_______________________________
Cardholder
As the Budget Manager, I agree to a review the transaction log and supporting receipts and sign off on the transaction log on a monthly basis.

Approval

_______________________________________________Date_______________________________
Budget Manager Approval (For Credit Limits & For Above Accounting Distribution)

Approval

_______________________________________________Date_______________________________
Dean/Other Approval

Please do not write below this line

Card Limits Assigned by Purchasing: Assigned Template #:_______________$ Limit/Transaction:________________ $ Limit/Month:_______________________ Date Card Issued: ____________________ Card Number:______________________________________________

Cardholder Signature:__________________________________________________________________________________
_________________________ _______________________________ _________________________________________ _____________

Date e-mailed to BofA

U.S.S. Approval

41001-46500 Treasury/Accounting Approval

7/02


								
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