L JPMORGAN CHASE BANK, N
GSA SmartPay2 - MasterCard Purchase Account Form
(Approving Official Setup/Maintenance Form)
TO BE USED INTERNALLY BY DEPARTMENT OF COMMERCE
DO NOT SEND TO JPMORGAN CHASE
| New |
|Change (Only Complete Fields To Be Changed) |
|Close |
|If Replacing an Approving Official, Name of Approving Official Being Replaced |
|Name: |
|Hierarchy Levels |Level 1 |Level 2 |Level 3 |Level 4 |Level 5 |Level 6 |
|(6 Required) | | | | | | |
|Approving Official Information Required |
|Agency/ | |
|Organization | |
|Name | |
|Approving Official’s | |
|Full Name | |
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|Address Line 1 | |
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|Address Line 2 | |
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|City | |
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|State | |
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|Zip Code | |
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|Email Address | |
|Work Phone | |
|Unique Pass Phrase First | |
|4 Characters of Mother’s | |
|Maiden Name (Required) | |
|Approval Required – A/OPC |
| | |Signature: |Date: |
|Prepared By: | | | |
|(Please Print) | | | |
| | |Signature: |Date: |
|Approved By: | | | |
|(Please Print) | | | |
|Completed Forms should be faxed to the servicing Agency Program Coordinator for processing. |
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