US Bank Visa Corporate Card Application
|[pic] |University of California, Davis |
| |OP ANR Business Operations Center |
| |US Bank VISA Corporate Card Application |
|Travel/Entertainment Questions: |
| |
|Have you had a university business related travel or entertainment expense in the last 12 months? | |Yes |
| | |No |
| |
|Do you anticipate incurring university business related travel or entertainment expenses in during the next 12 months? | |Yes |
| | |No |
|. |
|Note: If you answer “No” to both questions, your application for a US Bank VISA Corporate Card will not be forwarded. |
| |
|Application Procedures |
| |
|UC Davis employees with university business expense needs can apply for the card. |
|Complete this application, ensuring that all requested information is provided. |
|Sign application. |
|Send to: Kennieth Nasalroad, ANR Business Operations Center, 9240 So. Riverbend Ave., Parlier, CA 93648 |
| |
|Personal Information (Please Print) |
| |
|Name: | | | | |UC | |
| |(First, Middle, Last) | |Email: | |
| |
|Permanent Home Address (for billing purposes): | |, | | |
| |(Street, City, Zip Code) |
| |
|Payroll Title: | | |
| |
|Department: |OP ANR Business Operations Center - Kearney | |
| |
|Business Telephone: | | |Home Telephone: | |
| |
|Social Security #: | | |Date of Birth: | |
| |
|Proper Use Agreement |
| |
|I agree that use of the US Bank Corporate Card account is to be limited to University business entertainment and travel-related expenses only. I understand |
|that the information provided on this form will be provided to US Bank. |
| |
|Signature: | | |Date: | |
| |
|County Director Name: | | |Department Head Title: |County Director | |
| |
|County Director Signature: | | |Date: | |
| |
|Department Head Name: |Cherie McDougald | |Department Head Title: |Director |
| |
|Department Head Signature: | | |Date: | |
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|Card Activation |
| |
|Acceptable applications will be forwarded to US Bank by Accounting and Financial Services. Upon receipt of the card, cardholders will need to contact US Bank|
|at 1-800-344-5696 to activate the card and accept the terms and conditions as outlined by US Bank. A Social Security number will be required for card |
|activation. |
| |
|For Accounting and Financial Services Use Only |
| |
|Approving Office Signature: |
Department confirms that employee’s appointment is for less than 1 year duration for budgetary purposes only.
Department confirms that employee’s current appointment is less than full-time. However, position requires business travel.
Rev. 04/11/2011 Default DaFIS Account #:_ _
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