"Purchasing Card Request" - Virginia

Purchasing Card Request is a legal document that was released by the Virginia Department of Accounts - a government authority operating within Virginia.

Form Details:

  • Released on August 17, 2020;
  • The latest edition currently provided by the Virginia Department of Accounts;
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Commonwealth of Virginia
Purchasing Card Request
Agency Name and Number__________________________________________________
Date of Request: ______________
To: ______________________________________
Agency Program Administrator
A Purchasing Charge Card is hereby requested for the following employee under my
supervision (please print or type all information as requested below).
Employee Name as it should appear on the Card:
__________________________________________
Employee Mailing Address:
________________________________________________________________
Employee Work Phone: (______) _____________________
Employee ID Number: _____________________________
Employee’s Email: __________________________________
I hereby certify that I have examined this employee’s duties and estimate that the
purchasing card will be used for approximately ______________ transactions per month
at a dollar value range of $__________ to $__________ per transaction.
[NOTE: A “transaction” is one order placed with a vendor who accepts the card.]
Based on these estimates, I am requesting limits of $____________ per transaction
(Not to exceed $10,000) and $____________ total per month (not to exceed $100,000) be
placed on this card.
I agree and understand that, at least annually, the activity on all purchasing cards will be
reviewed to ensure limits and card restrictions are appropriate for the card’s usage. I will
provide written recommendations regarding any limit changes.
I further certify that I will review and approve this cardholder’s transactions and
supporting documentation on a monthly basis.
Signed: ______________________________________ Date: _____________________
Requesting Authority (Supervisor)
Signed: ______________________________________ Date: _____________________
Employee
Approved by Agency Program Administrator: __________________________________
Date entered into system: ______________
Revised August 17, 2020
Commonwealth of Virginia
Purchasing Card Request
Agency Name and Number__________________________________________________
Date of Request: ______________
To: ______________________________________
Agency Program Administrator
A Purchasing Charge Card is hereby requested for the following employee under my
supervision (please print or type all information as requested below).
Employee Name as it should appear on the Card:
__________________________________________
Employee Mailing Address:
________________________________________________________________
Employee Work Phone: (______) _____________________
Employee ID Number: _____________________________
Employee’s Email: __________________________________
I hereby certify that I have examined this employee’s duties and estimate that the
purchasing card will be used for approximately ______________ transactions per month
at a dollar value range of $__________ to $__________ per transaction.
[NOTE: A “transaction” is one order placed with a vendor who accepts the card.]
Based on these estimates, I am requesting limits of $____________ per transaction
(Not to exceed $10,000) and $____________ total per month (not to exceed $100,000) be
placed on this card.
I agree and understand that, at least annually, the activity on all purchasing cards will be
reviewed to ensure limits and card restrictions are appropriate for the card’s usage. I will
provide written recommendations regarding any limit changes.
I further certify that I will review and approve this cardholder’s transactions and
supporting documentation on a monthly basis.
Signed: ______________________________________ Date: _____________________
Requesting Authority (Supervisor)
Signed: ______________________________________ Date: _____________________
Employee
Approved by Agency Program Administrator: __________________________________
Date entered into system: ______________
Revised August 17, 2020