Procurement Card Maintenance Request Form

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Form FS 003 Maintenance Request for Procurement Card Services. Form structure last revised May 2012. NC Department of Public Safety. Cardholder's NameĀ ...
NC DEPARTMENT OF PUBLIC SAFETY Maintenance Request for Procurement Card Services

Cardholder's Name (Enter as shown on Procurement Card.)

Date of Request

Account Number

Position Number

Change Reasons (Select appropriate reason below.) From

Location Address

To

New Location Address State

City Close Account

Enter reason for request to close account in the space provided.

Name Change

From

To

Credit Line Change

From

To

Transaction Limit Change

From

To

NC

Zip

Enter reason for request to change transaction limit in the space provided.

Authorization 1. Authorized to Request Procurement Card (Supervisor, Plant Manager, Division designee) (Printed /typed name)

(Signature)

(Date)

(Signature)

(Date)

Job Title 2. Authorized to Approve Request (Division Director or designee) (Printed /typed name)

Job Title

For Department Card Administrator Use Only (Department Card Administrator's printed name)

(Department Card Administrator's Signature)

(Date)

(Department Card Administrator's printed name)

(Department Card Administrator's Signature)

(Date)

Fax Maintenance Request Form to: Procurement Support Services 919-715-3731 Form FS 003 Maintenance Request for Procurement Card Services Form structure last revised May 2012 NC Department of Public Safety

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