University of Rhode Island Purchase Card Application




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University of Rhode Island

Purchase Card Application

(Cardholder & Department Administrator Agreements must be submitted with Application)



Fax: 401.874.4825

Email: PCARD@etal.uri.edu

Mail: University of Rhode Island

Carlotti Administration Bldg.

75 Lower College Road, Rm 103, Kingston, RI 02881-1966


Applicant/Cardholder Information:

Type (select one)

Standard PCARD    

Standard + Travel PCARD     

(Addendum required)

Travel Only PCARD     

(Addendum required)

First Name:      

Middle Initial:      

Last Name:     

Email:      

Business Phone #: (   )     

Employee ID#:      

Department:      

Date of Birth:      

Country of Citizenship:      

Mother’s Maiden Name:      

Applicant’s Complete Business Mailing Address

Building & Room #:      

Street Address:      

City:      

State:   

Zip:      

Applicant’s Home Address

Street Address:      

City:      

State:   

Zip:      


Department Administrator/Approver Information:

First Name:      

Middle Initial:      

Last Name:     

Email:      

PeopleSoft User ID:      

Employee ID#:      


Default ChartField:

Account:    

Fund:    

Dept.:     

Program:     

Project:      


GRANTS: DESIGNATION OF ALTERNATE ACCOUNT (REQUIRED) this must be a funded account. Charges will only be made against an alternate account if a purchase card transaction cannot be documented as a reasonable and allowable charge against a budgeted grant category. NOTE: The alternate fund account CANNOT be another grant fund, i.e. Fund 500.
Grant Reserve ChartField:

Account:    

Fund (other than 500):    

Dept.:     

Program:     

Project:      


The following signatures are required:







     







Applicant Signature

Date







     










Dept. Administrator (Approver) (Print)

(Signature)







     










Dean, Director, or Dept. Head, as applicable (Print)

(Signature)










     







Director, Office of Sponsored Projects

(Required for ALL Fund 500 PCARD Requests)

Date










     







President’s Delegated Signature Authorization

Date





To be completed by the Office of the Controller


Default MCC Table _______ Single Transaction Limit $_________ Monthly Credit Limit $_________

     

     




Office of the Controller/PCard (Signature)

Date








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