Instructions for ProCard Application

1. Check one box to signify if this is a NEW application, a CHANGE or a request to DELETE/CLOSE an existing account.
2. Provide (print) the REQUIRED Card account information requested.
   1. Cardholder name
   2. Employee ID#
   3. Dept ID
   4. Cardholder email address
   5. Address: Line 1 - Business address, Line 2 - Department name
   6. Work phone
   7. City, State Zip Code
   8. Default project/grant to be used by cardholder
   9. Default account# to be used by cardholder (See Account list)
3. Printed name and signature of Departmental Director/Dean/or Chair. Enter Date signed.
4. Authorized Signature for default project/grant if different from above.
5. Cardholder must sign to confirm their information is correct.

Forward completed/signed application to the Purchasing Department, Attn: Karen Schweiger/ProCard Coordinator (Application may be faxed first and then original forwarded - Fax 562-6290)