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<br />11 <br />216348v2 <br />Attachment A.2 <br /> <br /> <br /> <br /> <br />Credit Card Request Form <br /> <br />To: Finance Director <br /> <br />From: <br />(Department Head) <br /> <br />Re: Request for Credit Card <br /> <br />The following employee is authorized to be issued a City of North St. Paul Credit Card for the <br />department indicated. The employee is fully aware of the Credit Card Policy and has provided a <br />signed Credit Card User Agreement form. <br /> <br />Full Name (print): <br /> <br />Signature: <br /> <br />Title: <br /> <br />Department: <br /> <br />Single Purchase Limit: <br /> <br />30-Day Purchase Limit: <br /> <br /> <br />I have read the City of North St. Paul Credit Card Use Policy and I understand the responsibility of <br />purchasing services and supplies using the City of North St. Paul Credit Card Program. I agree to <br />abide by the policy for the use of a credit card. I also understand that misuse of the card can result <br />in disciplinary action or may be cause for dismissal. <br /> <br /> <br /> <br /> <br /> <br />Signature of the Employee Date <br /> <br /> <br /> <br /> <br /> <br />Signature of the Department Head Date <br />