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STATE IOWA UNIVERSITY PURCHASING CARD PROGRAM Cardholder Application Name of Purchasing Card Applicant: Department Name & Address: Configuration Requested (check one): Standard Standard with Hospitality Cardholder ISU ID: (on the ISUCard, middle 9 digits only) Telephone Number (Work): Telephone Number (Home): Note: If card is for Study Abroad purposes, please request a Study Abroad card application from purchasing. Purchasing Card Process The Iowa State University purchasing department, in coordination with USBank and Elan Financial Services, will issue the Purchasing Card. Iowa State University Purchasing Card Program Cardholder Agreement and Application forms will be supplied to the department and must be completed and returned to the purchasing department with appropriate authorization before the Purchasing Card will be ordered. The cardholder must pick up the card in person from the purchasing department. At that time, the cardholder will be required to sign the back of the Purchasing Card and receive instructions on its use. The Purchasing Card dollar limit will be $3,000 per transaction, with departments having the option of setting lower limits. The monthly credit limit will be determined by the department, purchasing, and the Purchasing Card company, based on departmental need. The maximum credit limit allowed for each card per cycle month will be $10,000, unless special approval has been obtained from the director of purchasing. COMPLETE ONLY IF REQUESTING AMOUNTS DIFFERENT FROM THOSE LISTED ABOVE Limit per transaction: $ (not to exceed $3,000) $10,000 unless authorized here) Monthly credit limit*: $ (not to exceed _______________________________ *Please attach memo from department chair/director to explain request for higher monthly limit Director of Purchasing The cardholder and cardholder s department, upon receiving the monthly billing statement, will reconcile items to be sure that actual amounts charged for purchases are correct and match the billing statement charges. Discrepancies are the responsibility of the department to resolve. If there are charges the department wishes to dispute, it is the responsibility of the department to first contact the merchant to seek resolution. If not satisfied with the outcome, the department shall contact the Purchasing Card Program Administrator, within thirty (30) days after the transaction is posted, or ten (10) days of statement receipt, whichever comes first, to initiate a formal billing inquiry with lan Financial Services. The department shall validate, reallocate and approve all charges using the Purchasing Card on-line reconciliation system within thirty (30) days after the transaction is posted, or ten (10) days of statement receipt, whichever comes first. The original charge receipts and a copy of billing statement are to be maintained by the department for a period of five (5) years. This documentation is subject to audit. The department shall provide the following information for the on-line system database: (Validators and reallocators input data into the p-card reconciliation system in AccessPlus) Validator 1: Validator 2: Reallocator 1: Reallocator 2: Approvers are based on funds used in reallocation. ISU ID# (on the ISUCard, middle 9 digits only) Phone # Phone # Phone # Phone # ISU ID# ISU ID# ISU ID# Default fund account number (optional): Date Date Date Applicant Signature Department Chair/Director Approval Dean/Vice-President/Provost Approval Director of Purchasing _____________________ Approval ___________________________________________________ Date (LLFILES/PCARD/PCARD FORMS/PCARD APPLICATION) Revised January 2007 IOWA STATE UNIVERSITY PURCHASING CARD PROGRAM CARDHOLDER AGREEMENT The cardholder agrees, within thirty (30) days after the transaction is posted, or ten (10) days of receipt of the statement from USBank/ lan, whichever comes first, to provide all receipts to card validator to validate that accuracy of all charges. All card charges and associated fees will be the responsibility of the cardholder s department. Should a card be lost or stolen, the cardholder or cardholder s department is responsible for notifying USBank/ lan at 800-3445696, the ISU Purchasing Card Program Administrator at (515) 294-4589, and the ISU Public Safety Office at (515) 294-4428. The Purchasing Card is to be used only by the named cardholder and is not to be loaned to another employee, or other person. The cardholder has full liability for any improper charges that result from allowing others to use the card. Should a cardholder terminate employment with the university, or transfer to another university department, the s cardholder department has the specific obligation to notify the Purchasing Card Program Administrator prior to the employee's termination or transfer date. The cardholder may not make personal purchases on the card and then reimburse the university. As holder of this Purchasing Card, I agree to accept the responsibility for the protection and proper use of this Purchasing Card, as enumerated in this Agreement, the User Guide for Iowa State University Purchasing Card Program (User Guide), and Statement of Purchasing Card Receipt, which will be furnished when my card is received. I understand sales tax and federal excise tax can frequently be avoided by providing or drawing attention to the tax certificate numbers on the sleeve provided for the card. I agree the items shown below will NOT be purchased using this Purchasing Card. I further understand that improper or fraudulent use of the Purchasing Card may result in disciplinary action in accordance with the policies of ISU s Human Resource Services. Should I fail to use this Purchasing Card properly, I authorize the university to deduct from my salary, or from any other amounts payable to me, an amount equal to the total of the improper purchases. I also agree to allow the university to collect any amounts owed by me, even if I am no longer employed by the university. If the university initiates legal proceedings to recover amounts owed by me under this Agreement, I agree to pay legal fees incurred by the university in such proceedings. Cardholder agrees the following items will not be purchased using this purchasing card: Equipment Items valued at over $5000, with a useful life of +1 year & tagable for inventory Automatic Electronic Defibrillators (AEDs) Computers (except PDAs) Copiers Purchases involving trade of ISU property Telephones, cordless telephones, IP phones, cell phones & related equipment Services Construction services Repair & technical services* Professional services Moving services (employee relocation) Rental services Telecommunications services Items restricted due to standards/reporting issues Alcoholic beverages1 Controlled substances Firearms, weapons & ammunition Furniture, furnishings & artwork (except through Access+) Internet domain names Items from conflict of interest vendors2 Items from on-line auctions Laboratory animals, livestock, animal cages & aquariums Leases & rentals Pharmaceuticals & drugs Radioactive materials & hazardous materials Printing & photocopying Business cards & letterhead Postal & parcel services Photocopier supplies Cylinder gases & liquid nitrogen *without written authorization from purchasing Travel expenses Personal items & gifts Items available through ISU stores3 & services 1 2 Airline tickets Hotel rooms (including reservations) Meals Car rentals Parking fees Gasoline & fuel Hospitality expenses Meals & food for consumption Items for personal use Gifts benefiting an individual employee Donations Additional restrictions for cardholders without hospitality rights Entertainment expenses Interview expenses Hotel rooms for visitors to the university With regard to purchase of alcoholic beverages, please refer to university policy. Includes purchases from ISU employees, their spouses, minor children, associated businesses in which they have a 5% or greater ownership interest, and any sole proprietorship or partnership in which they have an interest. 3 Cardholders are expected to purchasing in-stock items at university stores unless substantial savings can be realized through alternative sources. External vendors cannot be used for printing or photocopying without consent of Printing Services in accordance with Board of Regents policy. The purchasing department shall communicate any changes to the list of restricted commodities to the Cardholder by email or interoffice memo. I agree to comply with any additional restrictions communicated to me, effective on the date of the email or memo. NOTE: Non-adherence to any of the procedures enumerated in the Agreement, the User Guide, or the Statement of Purchasing Card Receipt, will result in revocation of individual cardholder privileges and may result in revocation of all division or departmental Purchasing Cards. Questions concerning Purchasing Card procedures or purchases should be directed to the Purchasing Card Program Administrator, at (515) 294-4589 or llackore@iastate.edu. Applicant signature (LLFILES/PCARD/PCARD FORMS/PCARD APPLICATION) Date Revised January 2007

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