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CITY OF EUGENE <br />PURCHASING CARD <br />CREDIT CARD APPLICATION <br />❑ New Card A Change to Existing Card (last 8 numbers of the card 00~3q ) <br />Name (as it will appear on the credit card): _T4:FF1Zey J&4e FLOWri2S <br />User ID (i.e. cefnckp): CEWA.J-J Ir Employee ID # 1 <br />Work Telephone Number: C591) ey OZ- T~L(82- <br />Last four numbers of your Social Security &123 L (Used only to activate the card) <br />Org # 1392 ( Department Name: pupUC, W4eWivision Name: ADYVhNISTPA?IOA) <br />Work Mailing Address (address where renewal cards will be <br />0Z <br />974101 <br />E-mail address: '109-~~OI,JQt(5 r) to- o"e. ert US <br />Default account information: Fund ,3_r.Org_2WCct✓1'OZ OProgram - Project:_ <br />Authorized transaction (per charge) limit requested ($300 is default): $ <br />Authorized monthly spending limit requested ($3,000 is default): $ 3 1 Ow <br />Authorized usage: ❑Materials and Supplies Only or Materials, supplies and travel related <br />Intended use, estimated frequency of use and volume of charges: gL pktcc uAAnJ <br />Proxy/Approver: <br />Name/phone number of the person authorized for approving the voucher to pay the bill: <br />Name: SC AX-6, ?)A-nJMoL Phone: A g y 2 t 3 <br />User ID: COWASMS <br />Applicant's Signature: Date: 101-10 Z <br />Z N <br />Supervisor's Signa Phone: g//0 -t <br />/ U P <br />Approved by: Date: (n o _z <br />E ecutive Manag 's ignature <br />********For Purchasing's Use Only************ <br />Date request received: <br />Purchasing Manager's Approval: <br />Date Card Ordered: <br />City Credit Card Application - Rev 04/04 \\cesrv9o0\boa\cesrv900',boaN4ci-sd4w\P.c..nt card\Credit Card Application.doc <br />