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San Rafael Employees
This website is for City employees.
Credit Card Request Form
Cardholder Name
*
Required
First
Last
Email
Job Title
*
Required
Department
City Attorney
City Clerk
City Manager
Community Development
Library & Recreation
Digital Services & Open Government
Economic Development
Finance
Fire Department
Human Resources
Parking Services
Police Department
Public Works
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
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