SECTION I – APPLICANT INFORMATION
Last Name / First Name / Initial
Room and Building / Street Address (Bank will send monthly statements to address listed.)
City / State / Zip Code

SSN (last 4 digits ONLY for bank verification)

/ OSU Employee ID
0 – 0 – 0 0 – 0
Phone Number / Email Address (osu.edu only)
() -
SECTION II – CARD INFORMATION

Purchasing Card

Card is issued in a department’s name for use by authorized departmental personnel in accordance with Purchasing policies.

1st line of Card: (Department or Area Name): *Limit 25 characters
2nd line of Card: (VP or College Name): *Limit 25 characters

Travel Card

Card is issued in individual’s name for specific travel expenses.

1st line of Card: (Individual Name): *Limit 25 characters
2nd line of Card: (Department or Area Name): *Limit 25 characters

Group/Extended Travel Card

Card is issued for a specific trip for group travel (2 or more travelers) or for an individual’s travel that spans 7 or more consecutive days.

1st line of Card: (Individual Name): *Limit 25 characters
2nd line of Card: (Department, Area or Trip Name): *Limit 25 characters
Dates of Card Usage: to / T#
ATM* / *If ATM use is selected, the approving Senior Fiscal Officer will be contacted by the PCard Office with additional information.

Card Limits

Single, Transaction Limit (check one) / 30-Day Cycle Limit (check one)
Standard Transaction Limit / $ 1,000 / Standard 30-day Cycle Limit / $ 5,000
Optional Lower Transaction Limit / $ / Optional Lower Cycle Limit / $
Optional Higher Transaction Limit* / $ / Optional Higher Cycle Limit* / $
*On an exception basis and with proper documentation, including College/VP authorization, limits above the standard may be considered.
Default Chartfield Information (OSURF grants or endowment funds are not permitted.)
ORG: / Fund: / Account: 61206
Project: / Program: / User Defined:
SECTION III – FINANCIAL SYSTEM REALLOCATOR AND APPROVER (To be completed by the Senior Fiscal Officer)

Financial System Reallocator (Department must request Card Reallocator Role via OIT Security.)

Department Name and Address

Name / Phone
() -
OSU Email Address (osu.edu only) / Financial System User ID

Financial System Approver (Department must request Card Approver Role via OIT Security.)

Department Name and Address

Name / Phone
() -
OSU Email Address (osu.edu only) / Financial System User ID

SECTION IV – SIGNATURES AND APPROVALS

Applicant (required)
Signature /

X

/ Date
Department Approval (optional, as required by College/VP Area)
Printed Name
Signature /

X

/ Date
Senior Fiscal Officer (required)
Printed Name
Signature /

X

/ Date

Mail or fax application to: PCard Office

Purchasing

2650 Kenny Road

Columbus, Ohio 43210

Phone: (614) 292-9290 Fax: (614) 247-7121

http://purchasing.osu.edu/pcard

Revised March 2009

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