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) |

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|Name: |      |      |      | |UC |      |

| |(First, Middle, Last) | |Email: | |

| |

|Permanent Home Address (for billing purposes): |      |, |      |      |

| |(Street, City, Zip Code) |

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|Payroll Title: |      | |

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|Department: |OP ANR Business Operations Center - Kearney | |

| |

|Business Telephone: |      | |Home Telephone: |      |

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|Social Security #: |      | |Date of Birth: |      |

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|Proper Use Agreement |

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|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. |

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|Signature: | | |Date: | |

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|County Director Name: | | |Department Head Title: |County Director      | |

| |

|County Director Signature: | | |Date: | |

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|Department Head Name: |Cherie McDougald | |Department Head Title: |Director |

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|Department Head Signature: | | |Date: | |

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|Card Activation |

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|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. |

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|For Accounting and Financial Services Use Only |

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|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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