Print Form
For Office Use Only
Card # ______________________________
Department Code _____________________
Study Abroad Purchasing Card Application
Heirarchy Code _______________________
Training Emailed ______________________
Card Information
First Name
Last Name
WKU ID #
Date of Birth
Mail Stop #
Phone #
Cardholder
Email
Supervisor Email
Card Record Keeper
Record Keeper
Email
(Leave Blank if you are your own Record Keeper)
Study Abroad Program Information
Study Abroad Index #
Destination
Trip Dates
*Cash Advance Request $
(Optional)
*I hereby certify that:
I am personally and individually responsible for the safegurad of cash advance funds disbursed to me by the University; I will spend funds in
accordance with applicable University policies, return any unused funds to the University, and will complete a Group Travel Voucher no later
than 10 business days following the conclusion of the trip; and, I understand that if I fail to return the remaining balance, I will be required to
reimburse the Unviersity for an amount equal to the unused funds.
Failure to comply with the above statment may result in disciplinary action up to and including termination of employment.
Card Limits
*Limits may be changed by typing in a new amount. These changes MUST be accompanied by a statement of justification from the budge manager for the
study abroad index.
Single Transaction Limit $ 5,000
# Transactions Allowed per Day 15
Monthly Credit Limit $ 10,000
# Transactions Allowed per Month 100
Card Authorizations - Printed names and signatures required
Cardholder Printed Name
Record Keeper Printed
Name
Cardholder Signature
Date
Record Keeper
Signature
Date
(If Cardholder is also Record Keeper, complete only Cardholder Name and Signautre.)
Manager/Dept Head
Printed Name
Manager/Dept Head
Signature
Date
Study Abroad Director
Printed
Study Abroad Director
Signature
Date
Note to Cardholders & Manager/Dept. Heads:
Please be aware that by approving this purchasing card application for the card identified above, you are responsible for reviewing and
approving the card's transactions each month to ensure that all purchases are valid and in accordance with the Purchasing Card Procedures.
Furthermore, you are responsible for ensuring that there are sufficient funds in the respective budget(s). You also share accountability for all
transactions made against this purchasing card account during both internal and external audits.
Western Kentucky University
Purchasing Card Record Keeper Agreement Form
As a Records Keeper of a Western Kentucky University Purchasing Card, I agree to the following terms and conditions:
1.
I am responsible for ensuring that my card and account number, or the department card and account number, are
protected from theft or loss. I will immediately notify the Purchasing Card Administrator and/or PNC of any loss or improper use
of my card or account number, or the department card or account number.
2.
I am responsible for obtaining, for audit purposes, all proper invoices/receipts or other documentation necessary to
substantiate the propriety of each card transaction. I will retain all supporting documentation within my department, and
understand that the documents must be accessible for review purposes.
3.
I am responsible for reviewing my transactions daily/weekly in ActivePay and allocating the expenses to the appropriate
Banner index number and account code prior to the month-end billing cycle cutoff.
4.
I am responsible for reconciling my monthly purchasing card statement and resolving any discrepancies by contacting the
vendor or the bank within the timeframes noted in the Purchasing Card User's Guide.
5.
I am responsible for submitting the paper copy of the monthly card statement to my Supervisor to approve and sign no
later than the end of the following billing cycle. I will also sign the statement and retain the documentation for five (5) years.
6.
I understand that all transaction documentation and reconciliation's will be subject to audit by the Department of
Purchasing and/or Internal Audit.
7.
I understand that the University may terminate my right to participate in the Purchasing Card program at any time for any
reason. I will surrender the Purchasing Card to the University's Purchasing Card Administrator or my immediate supervisor upon
demand or upon my separation of employment with the University.
Cardholder
Signature
Print Name
Date
Manager/Department Head's approval denotes the following: I certify that the person assigned the duties of Records
Keeper will perform all responsibilities described in the agreement and in the Purchasing Card User's Guide. I
understand that if these responsibilities are not met that I/my department may lose authorization to participate in the
card program. It is also my responsibility to verify the charges and to verify that the monthly reconciliation process has
been completed by signing the paper copy of the card's statement.
Manager/ Dept Head
Signature
Print Name
Date
Western Kentucky University
Purchasing Card User Agreement
Participation in the Western Kentucky Purchasing Card Program is a privilege that also carries cardholder and user
responsibilities. The card is considered University property whether it is in Department's name or an individual's name, and
should be used only for University business in accordance with State Law and University policies. As a cardholder or user of a
Western Kentucky University Purchasing Card, the undersigned cardholder/user agrees to the following terms and conditions:
1.
I will use the card only in accordance with University policies, regulations, and procedures as stated within the
Purchasing Card User's Guide. I will also adhere to University price contracts, and will not manipulate/split orders over $2000 to
circumvent card limits.
2.
I understand this is NOT a personal purchasing card and I will not make any personal charges against my card under any
circumstances.
3.
I am responsible for ensuring that my card and account number, or the department card and account number, are
protected from theft or loss. I will immediately notify the Purchasing Card Administrator and/or PNC of any loss or improper use
of my card or account number, or the department card or account number.
4.
I am responsible for obtaining and submitting, for audit purposes, all proper invoices/receipts or other documentation
necessary to substantiate the propriety of each card transaction.
5.
I will surrender the Purchasing Card to the University's Purchasing Card Administrator or my immediate supervisor upon
demand or upon my separation of employment with the University.
6.
If the card is in my name, I understand that I am the only person entitled to use the Purchasing Card, and I am
responsible for all charges made against the card.
7.
I have reviewed the Purchasing Card Procedures and understand the requirements for the Card's use. I will follow the
established procedures for the use of the Card, and understand that failure to do so may result in either revocation of my use of
the Purchasing Card program or other disciplinary actions up to and including termination. I agree that I am personally
responsible for my improper or illegal use of the card, and I allow the University to collect any amounts owed by me for improper
purchases even if I am no longer employed by the University. Should I fail to use the Card properly, I authorize the University to
take whatever legal steps are necessary to collect an amount equal to the total of the improper purchases. If the University
initiates legal proceedings to recover amounts owed by me under this Agreement, I agree to pay all collection costs, including
reasonable attorney fees, incurred by the University.
Cardholder/User
Signature
Print Name
Date
Manager/Department Head's approval denotes the following: I certify that I will monitor and review the purchases made
by this cardholder/user in accordance with the Purchasing Card program's established rules and procedures for the
card user's agreement. It is also my responsibility to determine if the cardholder/user is using the card responsibly in
accordance with Purchasing and any other applicable Western Kentucky University policy, and to revoke the holders
use of the card if they are not using the card as intended.
Manager/Dept Head
Signature
Print Name
Date