"Purchase and Travel Card Program Administrator Form - Psub" - Virginia

Purchase and Travel Card Program Administrator Form - Psub is a legal document that was released by the Virginia Department of Accounts - a government authority operating within Virginia.

Form Details:

  • Released on June 9, 2021;
  • The latest edition currently provided by the Virginia Department of Accounts;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Virginia Department of Accounts.

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Commonwealth of Virginia
Purchase and Travel Card
PROGRAM ADMINISTRATOR FORM
PSubs Only
Agency Number:
Program (Check One):
***For CCA Use ONLY***
Purchasing Card Only
CCA
____________
IL Travel Card Only
ATC Card Only
Both TRAVEL Programs
ALL Card Programs
AUTHORIZED PROGRAM ADMINISTRATOR
ADD N
P
A
EW
ROGRAM
DMINISTRATOR
Name (Please Print) of Program Administrator to be ADDED Role (Primary or Backup)
Effective Date
(
)
(
)
Phone
Fax
E-mail Address
New Program Administrator’s Signature
Supervisor’s E-mail Address
DELETE P
A
(I
A
)
ROGRAM
DMINISTRATOR
F
PPLICABLE
Name (Please Print) of Program Administrator to be DELETED Role (Primary or Backup)
Effective Date
AUTHORIZING OFFICER OF AGENCY/ENTITY
I,
, an Authorizing Officer of
(Entity Name)
hereby authorize the following employee to act on behalf of the Agency in authorizing the applications of employees for a
Bank of America Visa Card. Program Administrators also have the ability to close accounts, change limits, modify industry
restrictions, and perform other program management functions related to the entity’s cards.
The individual listed below is hereby designated as an Authorizing Officer for this entity only:
Authorizing Officer (Please Print)
Title
(
)
Authorizing Officer’s Signature
Date
Phone
CCA Revised 6/9/2021
Scan and Email Page 1 only of this form to cca@doa.virginia.gov
Page 1 of 2
Commonwealth of Virginia
Purchase and Travel Card
PROGRAM ADMINISTRATOR FORM
PSubs Only
Agency Number:
Program (Check One):
***For CCA Use ONLY***
Purchasing Card Only
CCA
____________
IL Travel Card Only
ATC Card Only
Both TRAVEL Programs
ALL Card Programs
AUTHORIZED PROGRAM ADMINISTRATOR
ADD N
P
A
EW
ROGRAM
DMINISTRATOR
Name (Please Print) of Program Administrator to be ADDED Role (Primary or Backup)
Effective Date
(
)
(
)
Phone
Fax
E-mail Address
New Program Administrator’s Signature
Supervisor’s E-mail Address
DELETE P
A
(I
A
)
ROGRAM
DMINISTRATOR
F
PPLICABLE
Name (Please Print) of Program Administrator to be DELETED Role (Primary or Backup)
Effective Date
AUTHORIZING OFFICER OF AGENCY/ENTITY
I,
, an Authorizing Officer of
(Entity Name)
hereby authorize the following employee to act on behalf of the Agency in authorizing the applications of employees for a
Bank of America Visa Card. Program Administrators also have the ability to close accounts, change limits, modify industry
restrictions, and perform other program management functions related to the entity’s cards.
The individual listed below is hereby designated as an Authorizing Officer for this entity only:
Authorizing Officer (Please Print)
Title
(
)
Authorizing Officer’s Signature
Date
Phone
CCA Revised 6/9/2021
Scan and Email Page 1 only of this form to cca@doa.virginia.gov
Page 1 of 2
Program Administrator Form Instructions
This is the new Bank of America Visa Card Program Administrator form. This form is used to assign
Program Administrator responsibilities to a designated individual who will have the ability to
administer the Purchase and/or Travel Card Programs. PLEASE NOTE: This form is specifically for
those who need access to full Program Administrator functions.
All items on the form are required.
Agency Number: Localities and Authorities will use your Charge Card Program assigned number.
Program: You must designate what program or programs the New Program Administrator listed will
require access to; Purchasing Card Program, Travel Card Program, or both.
AUTHORIZED PROGRAM ADMINISTRATOR
Add New Program Administrator: This information pertains to the individual you are requesting to
be set up as a New Program Administrator or as a Backup. Please complete a separate form for each
individual Program Administrator.
1. Name – New Program Administrator’s printed name.
2. Role – Role the designated individual will perform (Primary or Backup).
3. Effective Date – Date Program Administrator is to be added.
4. Phone – Telephone number (including extension) and fax number (including area code).
5. E-mail Address – Current E-mail address.
6. New Program Administrator’s Signature – New Program Administrator’s signature.
7. Supervisor’s E-mail Address – New Program Administrator’s Supervisor’s E-mail address.
Delete Program Administrator: This information pertains to the individual you are requesting to
delete as a Primary Program Administrator or as a Backup. Please complete a separate form for each
individual Program Administrator.
1. Name of Program Administrator to Be Deleted – Program Administrator’s printed name.
2. Role – Role the designated individual performed (Primary or Backup).
3. Effective Date – Date Program Administrator authorization is to be deleted.
AUTHORIZING OFFICER OF AGENCY/ENTITY
Authorizing Officer: This must be your Agency/Entity head or designee.
Entity Name: Enter your complete Agency/Entity name.
1. Authorizing Officer – Authorizing Officer’s printed name.
2. Title – Authorizing Officer’s title.
3. Signature – Authorizing Officer’s signature.
4. Date – Date of authorization request.
5. Phone – Telephone number (including extension).
Scan and Email Page 1 only of this form to cca@doa.virginia.gov
Page 2 of 2
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