Credit Card Request Form

This website is for City employees.

Cardholder Name * Required
First Last
Email
Job Title * Required
Department
Requested Action
- New card request
- Card cancellation
- Temporary limit increase
- Permanent limit increase
Effective Date
MM slash DD slash YYYY
Limits (subject to Finance Department approval)
Single purchase limit 30-day purchase limit
Reason for new card request
- New employee
- New need for card for existing employee
- Card lost/stolen
- Other
Reason for card cancellation
- Employee no longer with City
- Card no longer needed for existing employee
- Card lost/stolen
- Other
Department Account Manager
Name
First Last
Job Title
Email
Authorization
By checking the consent box, requestor has obtained authorization from their Department Account Manager. A copy of this Credit Card Request form will be sent to Department Account Manager.
Consent * Required
I acknowledge that I have read and agree to the above Authorization Terms.
Additional Notes

Single purchase limit	30-day purchase limit

Department Account Manager