ProCard Participation Form

Request Type*

Please select one

Select

Business Unit*

Select

Requestor Name*

Type in the person's name who is filling out this form. Select "Send me a copy of my response" and provide your email at the bottom if you want a copy of this request.

Cardholder Legal Name*

Type in procard cardholder's legal name

Modification Type

Please select all that apply.

Select or enter value

Is Cardholder legal name also the preferred name on the procard?*

If no, please provide the preferred name for Procard below

Select

Preferred Name for Procard*

Current Cardholder Name*

New Cardholder Name

Cardholder Employee ID Number*

Must be 9 digits

Cardholder Phone Number*

Phone number required

Phone

Cardholder Email Address*

New Approving Official*

Approving Official*

Back-Up Cardholder Name*

Must not be approving official or back-up approver

Back-Up Approver Name*

Must not be approving official or back-up cardholder

Single Transaction Limit*

Note: $5,000 max limit, please consider budget and need.

Open credit liability: Procard Admin will review annual and adjust down if needed.

30-Day Transaction Limit*

Note: $50,000 max limit, please consider budget and need.

Open credit liability: Procard Admin will review annual and adjust down if needed.

What chartfield element would you like to change?

Please select all that apply.

Select or enter value

Default Chartfield Account*

Default Chartfield Fund*

Default Chartfield Department*

Select

Default Chartfield Program

Default Chartfield Class

Default Chartfield Project

Reason for cancellation

Effective July 1, 2024*

Please select "Yes' or "No"

Select or enter value

Form Approver*

The form approver may not approve their own procard request and may not approve procard request of their supervisor.

Select

Send me a copy of my responses

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