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PROCUREMENT CARD MAINTENANCE FORM (Please print or type information) Agency Name:

Valencia College

Cardholder Name: ________________________________________________________________________________ Cardholder’s phone extension: ________________________Department ____________________________________ Cardholder Name Change Name as it currently appears: ________________________________________________________________________ Name as it should appear: __________________________________________________________________________ Signature of new name: ____________________________________________________________________________

Account Cancellation For lost or stolen cards, please contact JPMorgan Chase at 1-800-270-7760 anytime Lost/Stolen_________

Employee Resigned__________

No Longer needed__________ Suspected Fraud ____________

Other: __________________________________________________________________________________________ Any Lost/Stolen or Suspected Fraud cards are subject to a written Security Report. No new cards will be issued without a Security Report. Credit Line Change Single Transaction:

FROM $__________________ TO $________________ Reset __________________

Monthly Limit:

FROM $__________________ TO $________________ Reset __________________

Length of time needed: (Up to three months) ___________________________________________________________ Justification: ______________________________________________________________________________________

The Cardholder, Budget Manager & PCard Administrator must sign this form prior to processing.

Cardholder Signature: _______________________________________________________________ Date: ______________

Budget Manager’s Name: (print) ______________________________________________________ Date: ______________ Budget Manager’s Signature: __________________________________________________________ Date: ______________

Approval if Cardholder & Budget Manager are the same: ___________________________________ Date: ______________ (Direct Supervisor)

Forward this Maintenance Form to: Procurement, Attn: PCard Administrator, MC 4-42, Fax 1209

Procurement Office Use only PCard Administrator’s signature ___________________________________________________________ Date changes made ________________________

Form Version 1.6

updated 11/2011

Valencia College

/MaintenanceFormVer1.6Nov2011  

http://valenciacollege.edu/procurement/documents/MaintenanceFormVer1.6Nov2011.pdf