Application Form for or Works User Access Card Received Personal Information: First Name: Middle Initial: Last Name: Date: @okstate.edu 9- Address: CWID: Position Title: Group Name: Billing Information Business Address Line 1: Business Address Line 2: USA City: State: Zip: Country: (405)744-8408 Business Phone: ( ) - Secondary Business Phone: Cardholder? Fund: Card Information and Controls Card Requested? If yes, name on card: Y If yes, department name on card: / Role(s) Use checkboxes: Credit Limits (transaction/monthly): – [select from drop down box] N Cardholder Approving Manager Provide justification for monthly credit limit over $10,000: Accountant Group Proxy Reconciler GL Coder (ability to change account numbers and subcodes) Group Owner Signatures and Date: Signature of Cardholder Date Signature of Approving Manager Date Signature of Accountant Date Signature of Department Head Date Signature of Fiscal Officer (if required) Date Signature of Purchasing Department Date Airfare Lodging Incremental (optional): $ Will you use this card while in a foreign country? Yes No Notes: [Administrative Use Only]
Card Received Date: Cardholder? Y / N Application Form for or Works User Access Personal Information: First Name: Middle Initial: Last Name: Address: @okstate.edu CWID: 9- Position Title: Group Name: Billing Information Business Address Line 1: Business Address Line 2: City: State: Zip: Country: USA Business Phone: ( ) - Secondary Business Phone: (405)744-8408 Fund: Card Information and Controls Card Requested? If yes, name on card: If yes, department name on card: Role(s) – Use checkboxes: Cardholder Approving Manager Accountant Group Proxy Reconciler GL Coder (ability to change account numbers and subcodes) Group Owner Credit Limits (transaction/monthly): [select from drop down box] Provide justification for monthly credit limit over $10,000: Signatures and Date: Signature of Cardholder Date Signature of Approving Manager Date Signature of Accountant Date Signature of Department Head Date Signature of Fiscal Officer (if required) Date Signature of Purchasing Department Date Airfare Lodging Incremental (optional): $ Will you use this card while in a foreign country? Yes No Notes: [Administrative Use Only]
Application%20Form%20for%20Pcard%20or%20Works%20User%20Access.docx