Form PC-1A "Purchase Card Request Form - Individual" - Rhode Island

What Is Form PC-1A?

This is a legal form that was released by the Rhode Island Department of Administration - a government authority operating within Rhode Island. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2014;
  • The latest edition provided by the Rhode Island Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PC-1A by clicking the link below or browse more documents and templates provided by the Rhode Island Department of Administration.

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Download Form PC-1A "Purchase Card Request Form - Individual" - Rhode Island

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PC-1a
7/14
State of Rhode Island
Department of Administration
Office of Accounts and Control
PURCHASE CARD REQUEST FORM - INDIVIDUAL
Cardholder Information:
Cardholder’s Legal Name:
Home Address: ________________________________________________________________
Country of Citizenship:_____ ___________________ Date of Birth: _____________________
Department:
Hierarchy Node:
Is PaymentNet4 Access Required?
No
Yes (PC-5 Required)
Complete Business Address:
Email Address:
Business Phone:
Card Information:
Approver’s Name:
Approver’s Email:
Limit # of transactions per day to
Limit # of transactions per month to
Limit $
per transaction*
Limit $
per month *
* Explanation/Justification for increase (if applicable):
List Default Accounting Needed:
Fund Agency
Line Item Sequence:
Natural Account:
Cost Center:
Type/Print Name of Authorized Agent
Signature of Authorized Agent/Date
PC-1a
7/14
State of Rhode Island
Department of Administration
Office of Accounts and Control
PURCHASE CARD REQUEST FORM - INDIVIDUAL
Cardholder Information:
Cardholder’s Legal Name:
Home Address: ________________________________________________________________
Country of Citizenship:_____ ___________________ Date of Birth: _____________________
Department:
Hierarchy Node:
Is PaymentNet4 Access Required?
No
Yes (PC-5 Required)
Complete Business Address:
Email Address:
Business Phone:
Card Information:
Approver’s Name:
Approver’s Email:
Limit # of transactions per day to
Limit # of transactions per month to
Limit $
per transaction*
Limit $
per month *
* Explanation/Justification for increase (if applicable):
List Default Accounting Needed:
Fund Agency
Line Item Sequence:
Natural Account:
Cost Center:
Type/Print Name of Authorized Agent
Signature of Authorized Agent/Date