J.P. Morgan Chase & Company
P.O. Box 57510
Salt Lake City, UT 84157-0510
EMPLOYEE INFORMATION
Middle Initial
Actual Street/Shipping Address
Campus Mailing Address
State
Zip + 4
Date of Birth
(Month/Year)
Last 4 Digits Only
CONTACT INFORMATION (Please return application to the address below)
TN
State
$500 Single Transaction/ $5,000 per Month
$1,000 Single Transaction/ $10,000 per Month
$2,000 Single Transaction/$10,000 per Month
$3,000 Single Transaction/ $25,000 per Month
Hierarchy ID
(Hierarchy ID - For Program Administrator Use Only)
EMPLOYEE/APPROVAL SIGNATURES
Date
Date
Date
Date
Dean/Admin Officer/Chair/Director Signature
Procurement Services
Dean/Admin Officer/Chair/Director (Printed Name)
Procurement Card Administrator
____________ Single Transaction ____________ per Month
(ex. Budget Center 1-23-456-7890)
(ex. 60040 Office Supplies)
Supervisor/Manager Signature
Applicant/Cardholder Signature
Default G/L Account Number
PROCUREMENT CARD APPLICATION
E-Mail Address
Last Name
Department/Address
VUNET ID
City
( )
Administrator Name Business Phone
First Name
Default G/L Center Number
Procurement Services, Baker Bldg 110 21st Avenue South, Suite 805 Box 357000, VUSta B
Procurement Card Administrator (615) 322-4985
Mother's Maiden Name
Social Security Number
Department/College/Division Name
Business Phone
Single Transaction Limit/Monthly Credit Limit (Choose One)
Optional Limits:
Must not exceed $3,000 per single transaction
37203
Zip
Nashville
City
Vanderbilt University
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J. P. Morgan Chase & Company
P.O. Box 57510
Salt Lake City, UT 84157-0510
GENERAL LEDGER CENTER INFORMATION
Please list all G/L budget center numbers applicable to the Cardholder for reassignment of procurement card expenses
Cardholder Name
Location of Record Retention
Supervisor/Manager Signature
PROCUREMENT CARD APPLICATION
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