VISA TRAVEL CARD APPLICATION by llr93689

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									                              UND VISA TRAVEL CARD APPLICATION
                                               For UND Benefited Employees
                 Complete form (please type) and submit both pages to Accounting Services, Mail Stop # 8356
Account Request:
        New Account                                                                       Name Change
        Address Change                                                                    Credit Line Adjustment to _____________
        Department/Division Change                                                        Single Transaction & Limit
        Account Closure – Termination or Voluntary
EMPLOYEE APPLICATION INFORMATION

____________________________________________________________________________________________
EMPLID Number

____________________________________________________________________________________________
Name (First, MI, Last – as shown on payroll records)                                      Email Address

____________________________________________________________________________________________
Street Address (for statements to be mailed)

____________________________________________________________________________________________
City                                                                                      State                               Zip

____________________________________________________________________________________________
Home Phone                              Business Phone                                    Departmental Mail Stop #

UND TRAVEL CARD___________________________________________________________________________________________
(To be embossed on card)
FOR ACCOUNTING SERVICES USE ONLY
UNIVERSITY OF NORTH DAKOTA___________________________________                                                _________________
Organization Name                                                                                               FAX Date:

Monthly Credit Limit:                   $5,000              Single Transaction Limit:     $ N/A              _________________
                                                                                                             Acct. Svcs Approval
Limit Per Day:                          $ N/A               Transactions Per Cycle:       $ N/A

                                                            Circle One:         Include            Exclude

Hierarchy/Unit Reporting:
Organization (TBR1)             VP (TBR2)                College (TBR3)         Department (TBR4)               TBR5                TBR6
10201

ELAN FINANCIAL SERVICES USE ONLY
Processing (circle one):   Regular                          Priority

Data Entry Exceptions:        __________________________________________________________________________________________

Card Delivery (circle one):   Airborne Regular Mail

Alternate Address:            __________________________________________________________________________________

                                        __________________________________________________________________________________

                                        __________________________________________________________________________________
         Attachment                    (If yes, please complete authorization worksheet and enter template name)

____________________________________________________________________________________________
Authorization Template Name                                                            Bank (numeric)

____________________________________________________________________________________________
Initiator                       IPC                    JI                              Agent (numeric)

AC Name Extension:            ______________________________________________________________________________________

                                                                       Page 1 of 2
                                                                                                                                     10/30/2009
                       UND Employee VISA Travel Card Agreement
Name of Employee (cardholder name as shown on payroll records):


Employee’s EMPID:

Division:                                             Department Name:


The CARDHOLDER agrees to and is responsible for:
     Ensuring that all charges made to the card are for allowable business-related travel expenditures; The cardholder
      may not make personal purchases on the card, or use the card for purposes that are outside the scope of the
      employee’s normal business-related travel expense needs or authority. Misuse of the card may be grounds for
      revocation of card privileges, potential disciplinary action, termination of employment, and possible criminal
      prosecution.
     Making payment for all charges on the monthly cardholder billing statement in a timely manner and in accordance
      with issuing bank (Elan Financial Services) policies. If a card is lost or stolen, the cardholder has the responsibility
      to immediately notify the issuing bank (Elan Financial Services at 800-393-3526).
     Verifying the accuracy of the charges upon receipt of the monthly cardholder billing statement;
     Upon termination, immediately cease use of the VISA Travel Card and submit card to department head/supervisor;
     Upon transferring between UND departments, immediately notify Accounting Services and submit new Employee
      VISA Travel Card Agreement form (with new department head/supervisor’s signature);

As a cardholder of a VISA Travel Card, I understand and agree to accept the responsibility for the protection and proper use
of this card, as detailed above and established UND Policies and Procedures. I understand that non-adherence to any of the
above procedures may result in revocation of individual cardholder privileges, potential discipline or termination, and
possible criminal prosecution.

            Signature: __________________________________________________ Date: _______________
                       Cardholder

The DEPARTMENT HEAD/CARDHOLDER’S SUPERVISOR is responsible for:
     Upon termination of employee, immediately contacting Accounting Services to have the account closed and to
       reclaim and destroy the card as part of the employee’s termination check-out procedure.
     Upon employee’s transfer of employment between UND departments, immediately contacting Accounting Services
       to provide the employee’s new departmental information.

     As Department Head/Cardholder’s Supervisor, I approve the issuance of a VISA Travel Card to the above-named
     employee. I understand and agree to accept the responsibility for the protection and proper use of the VISA Travel
     Card, as described above and according to established UND Policies and Procedures.

     Approval: __________________________________________________ Date: _______________
               Department Head/Cardholder’s Supervisor

Submit completed form (both pages) to Accounting Services, Mail Stop # 8356. Accounting Services will notify employee
upon receipt of the employee’s VISA Travel Card (approx. 10 business days). Employee is required to pick up their VISA
Travel Card within 5 business days.

        THIS SECTION TO BE COMPLETED WHEN EMPLOYEE RECEIVES VISA TRAVEL CARD IN
                                  ACCOUNTING SERVICES

I, the cardholder, acknowledge receipt of the VISA Travel Card. PLEASE SIGN YOUR CARD IMMEDIATELY UPON
RECEIPT.

Signature: _____________________________________________ Date: _______________
           Cardholder
                                                         Page 2 of 2                                              10/30/2009

								
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