State of Florida Purchasing Card Program
Cardholder Profile Information
Action Requested: Add Change Cardholder Name Only Close Account Change Other, Please Describe:
AGENCY NAME / FL Division of Emergency Management / CARDHOLDER INFORMATIONCARDHOLDER NAME (21A/N) /
*
/ DIVISION /DEM
SSN (8 N) / * / BUREAU /*
CARD MAILING ADDRESS (32 A/ N) / 2555 Shumard Oak Blvd / BUSINESS ADDRESS / 2555 Shumard Oak BlvdCARD MAILING ADDRESS (32 A/ N) / BUSINESS ADDRESS
CITY, STATE (27) / Tallahassee, FL / CITY, STATE / Tallahassee, FL
ZIP (9) / 32399-2100 / ZIP / 32399-2100
PHONE NUMBER (10) / PHONE / *
MCCG NAME / MCCG DESCRIPTION
DEM TRAVEL / TRAVELER
OTHER INFORMATION / CARDHOLDER AUTHORIZATION CONTROLS / AGENCY ACCOUNTING INFORMATION
Plastic / Credit Limit $ / Org (L1-L5 31800600
Bypass MCCG Table / Single Transaction Limit $ / EO AB
Foreign Currency Yes No / Daily Dollar Amount $ / VR 00
Foreign Currency Action: Decline Approve / Daily Transactions / Object 261000
Approve but Report / Monthly Dollar Amount $ / Group Identifier (9 A/N) DEM____
Monthly Transactions / Distribution ( Y/N) Yes
Cycle Dollar Amount $ / SAMAS ID
Approvers are:
/ Cycle Transactions / Levels of Approval Required (1-8) 1, 3, 4, 5, 8Requestor’s Signature & Date: *
/ Supervisor’s Signature:* / P-Card Administrator’s Signature:*Requestor’s Name – PRINTED*
/ Supervisor’s Name – PRINTED:* / P-Card Administrator’s PRINTED:*(Attachment A)