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<br />12 <br />216348v2 <br /> <br />Fund/Department Requestor Date Card # (Last 4 Digits) <br /> <br /> <br /> <br /> <br />Vendor <br />Vendor Address <br /> <br /> <br />For Product or Supplies Purchases <br />Product Quantity Product Description Price Each Total Price <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />For Registrations of Conferences / Meetings / Trainings <br />Name of Attendee Date of Conf/Mtg Location <br /> <br /> <br /> <br />Business Purpose of Each Product or Registration: <br />Is the Purchase <br />Budgeted: <br /> Yes <br /> No <br />Account Codes: <br /> <br /> <br /> <br /> <br /> <br />If Requestor Does Not Match the Cardholder <br />Name on Credit Card Date Card Taken Date Card Returned <br /> <br />Cardholder Approval <br /> <br /> <br />Attachment A.3 <br />City of North St. Paul <br />Credit Card Purchase Request Form <br />For Purchases Under $2,000 <br />I Acknowledge Having Read the Purchasing Policy (Please Sign):