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PROCU REM ENT CARD APPLICATION <br />Name : <br />Mailing Address: <br />Telephone Number: work home <br />fax <br />Email Address: <br />Department: <br />:::: }::: �::: :.::::::::::::.::::::;:: :: :: � :::::: ::::::: ::::::::::::: ::::: <br />:::;: ti :,:: :::::: �:::: � �: : �:::::: ;::: ::: :::: :::: .:: r::::::::::: :::::::r:::: � :::::: <br />`�'��r:::�:::::�:�::::� :::: ` :::::.::::.: ::::.:�.:.::.::.::::� ::::..:::::..:; :�.:::: <br />..:�:.::::::.::::.::::..:.::.:::.... <br />. ���. �����ii�`:::::::.::::.`...�..:::.::..�.::.����:...����...:.::::�:::::..r::::..::::..:�::::::::;:::::....::::::..:::.:.:::::::::::.�::::::.:�::::..:::::.: : <br />:: ::::::: ::: : : ::....:::...... .::;:::::::::::::::::: <br />.............................:...:.:............................... ........:............. .: ..� :...�� . �.�.�:�.��::::::::�:�:�..����� <br />.::.:�::::.::.::.:::::::::.:...::::::::::::::::.:.:::::::.::.::: <br />.�`::::::::::::::::::::::::::::::�.::.::::.::::.:::.:::r:.::::::::.:�::.:::::..::::.::.::::::.:::.::.:::::.:::.::::.:::.:::.::.�:.::.::.::::.::.::.::::.:::::::.::::.::. <br />......................................................................................................................................................................................................................................:.:,:.::.::.::.:::.:::::::.::.::::::.: <br />Transaction Limit: Monthly Spending Limit: <br />Restricted to Certain Types of Merchants: Yes No <br />If restricted — what types <br />Department Director Approval: Date: <br />City Administrator Approval: Date: <br />Finance Director Approval: Date: <br />Card Requested: Card Received: <br />Training Completed: User Agreement Signed: <br />Card Issued: <br />Card Returned: Final Bill ReceivedlApproved: <br />The City of Arden Hills Page 2 10/7/2008 <br />