online mastercard application

Document Sample
online mastercard application Powered By Docstoc
					                                                                   Purchasing Card
              Cardholder's Profile - Application Form
    By signing below, I consent to having the information collected by the University of Alberta on behalf of the
    National Bank Canada for the purpose of securing a Corporate Purchasing Card, National Bank MasterCard.
    Personal information is protected under the Freedom of Information and Protection of Privacy Act.
    For more information, contact the Plan Administrator.

1 Corporation Identification
    U N I V E R S I T Y                             O F     A L B E R T A                  7 8 0      4 9 2 - 7 3 6 6
    Name of the corporation - Maximum 22 characters                                      Area code    Telephone Number            Ext.

    B A R B               H U B B A R D                                                                  7 8 0       4 9 2        0 6 0 7
                                                                                                         Area code   Fax Number

2 Cardholder Information
*                                                                                    *
    Last Name                                                                            First Name


* Sex            M        F          * Birth Date
                                                          D D M M Y Y       * Mothers maiden name - Maximum 20 characters

* DEPARTMENT NAME




*
    Area code         Telephone Number                      Ext.      Area code   Fax Number


4 Card parameters
    DEFAULT SPEED CODE & ACCOUNT

* A


*   Monthly                                           $             DEFAULT LIMIT $10,000.00


*   Per transaction                                   $             DEFAULT LIMIT $2000.00


      CHECK BOX IF AUTHORIZING:

            ALBERTA 1 - CATERING                                         ALBERTA 2 - HOSTING AND CATERING


5 Authorization

* EMPLOYEE
                                  Signature                                 Printed Name                                 Date


* DIRECT
  SUPERVISOR
                                  Signature                                 Printed Name                                 Date


* SITE
  COORDINATOR
                                  Signature                                 Printed Name                                 Date
     MasterCard Application.xls                                                                                                          6/13/2006

				
DOCUMENT INFO
Shared By:
Stats:
views:22
posted:12/21/2008
language:English
pages:1