City of Mission Viejo - CSMFO



100584048895City of WestminsterRequest, Authorization and Cardholder Acceptancefor Bank of America Visa Credit CardCity of WestminsterRequest, Authorization and Cardholder Acceptancefor Bank of America Visa Credit CardAs Director of the______________________Department, I request that the following employee be authorized to participate in the City’s Bank of America Visa Credit Card program (“P-Card Program”). This procurement card will be used strictly for official City of Westminster business.Name of Employee:Title:Phone Number:Approving Supervisor:-4572011810901125855118110Section Below Completed by Administrative Services Department0Section Below Completed by Administrative Services DepartmentSingle Transaction Limit: 30-Day Limit (credit limit): Any special restrictions or considerations: Administrative Services Director Signature: _____________________________________________Date: ________________-4572013462001335405134620Section Below Completed by Cardholder and Returned to Administrative Services Department00Section Below Completed by Cardholder and Returned to Administrative Services DepartmentI, ___________________________, hereby acknowledge receipt of City of Westminster Bank of America Visa credit card, with the account number:____________________________________.As a cardholder, I have read, understand and agreed to comply with the terms and conditions of this agreement and the Bank of America Visa credit card policies and procedures. I will be responsible for the security of the card while in my possession. If lost or stolen, I will immediately notify Bank of America, my immediate supervisor and the Program Administrator in the Administrative Services Department.I agree to use this card only for City of Westminster business purposes and not for any personal purchases. I understand that the City will audit the use of this card and report any discrepancies. I understand that improper use of this card will result in disciplinary action, up to and including termination. Where theft of the card is suspected, I will cooperate with the pertinent law enforcement agency in case of an investigation and possible prosecution. I further understand that the City of Westminster may terminate my right to use this card at any time for any reason. I agree to return the card to the City immediately upon request or upon separation of employment.I understand that I am limited to the dollar amounts listed above when using this Bank of America Visa credit card for official City of Westminster purchases.Employee/Cardholder Signature: _____________________________________Date: _________________Administrative Services Director Signature: _____________________________Date: _________________Distribution:5574030172721Revised 01/15/20140Revised 01/15/2014Human Resources (Employee’s File) – Original Purchasing – Copy Cardholder - Copy ................
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