SSUPurchasing

Forms and Manuals

Addendum to PCard Application (Word)

This form is used to change information on an existing PCard account (i.e. change the PaymentNet reviewer, cardholder limits, billing address, etc.). It is also used when to close PCard accounts. Upon completion, this form should be submitted to the PCard administrator in the Purchasing Department.

Approval of Expenses Statement (Word)

Approval of Expenses Statement (PDF)

Complete and attach this form to the monthly statement to reflect transaction approval.

Cardholder Agreement (Word)

Cardholder Agreement (PDF)

Each cardholder must sign this form, which indicates their agreement to the terms and conditions of the PCard program, prior to obtaining a card.

Cardholder Application (Excel)

Complete this form to request a Visa card for an employee.

Change of Address (Word)

Change of Address (PDF)

Conflict of Interest (Word)

Conflict of Interest (PDF)

Credit Confirmation (Word)

Credit Confirmation (PDF)

This form is used when a credit receipt cannot be obtained from the supplier. It helps identify the nature of the credit and states the amount received is ultimately correct. The completed form should be attached to the cardholder's monthly statement.

DMA Form (PDF)

DMA Instructions (PDF)

Kentucky Sales Tax Blanket Exemption (PDF)

This form is supplied to merchants in the state of Kentucky as proof of our sales tax exemption. The form may be downloaded and printed as needed.

Missing Receipt Affidavit (Word)

Missing Receipt Affidavit (PDF)

This form is for use with purchasing card or travel expense transactions when you have exhausted all means of obtaining an itemized receipt. Completed signatures are required to make this form acceptable. Important: This option should be used infrequently and must include your explanation and signature and the signature of the individual having approval authority for the PCard account. Any substantiating documents available should also be attached to the PCard statement.

Ohio Sales Tax Blanket Exemption (Word)

Ohio Sales Tax Blanket Exemption (PDF)

This form is supplied to merchants as proof of our Ohio sales tax exemption. The form may be downloaded and printed as needed.

PCard Manual (Word)
PCard Manual (PDF)

PCard Transaction Log (Excel)

Purchase Order Terms & Conditions (Word)

Request for Payment (Word) NEW

Request for Waiver of Competitive Bidding (Word)
Request for Waiver of Competitive Bidding (PDF)

Statement of Disputed Items (Excel)
Statement of Disputed Items (PDF)

Supplier Non-Acceptance (Word)

Supplier Non-Acceptance (PDF)

This form is used to provide information about any vendor who does not accept the PCard. Submit it to the PCard administrator, who will work with the bank to gain future supplier acceptance.

Transportation Contract (Word)
Transportation Contract (PDF)

Transportation Terms & Conditions (Word)
Transportation Terms & Conditions (PDF)