The University of Memphis
Purchasing Cardholder Enrollment Form
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Return form to: Procurement Serivces
ATTN: Purchasing Card Coordinator
115 Administration Building, Memphis, TN 38152
Fax: 2102

CARD TYPE: PURCHASING CARD

Cardholder Authorization Parameters
Single Spending limit: Daily Spending limit: Monthly Spending limit:
Per transaction: Contact card Reviewer regarding limit concerns

Cardholder Information
Name on the Card (24 characters):
Job Title: Last Four Digits Social Security Number:
Department:
Default FOPAL:
  Fund Organization Program Activity
E-mail address: Office Phone Extension: Home Phone Number:

Administrator
Name of Card Administrator: Phone:
Job Title: E-mail:

Reviewer
Name of Reviewer: Phone:
Job Title: E-mail:

By my signature, I certify that I will abide by all policies and guidelines related to the use of and processes pertaining to the University of Memphis Purchasing Card.

__________________________________________
Cardholder Signature

____________________
Date


__________________________________________
Administrator Signature
____________________
Date

__________________________________________
Reviewer Signature
____________________
Date

As the Department Head, I agree to notify Procurement Services within seven (7) business days of the termination or transfer of the above-named cardholder, reviewer, or administrator and to abide by other policies and guidelines pertaining to the University of Memphis Purchasing Card.

__________________________________________
Department Head Signature 		____________________
Date
The University of Memphis, one of the Tennessee Board of Regents institutions, is an Equal Opportunity/Affirmative Action University.