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ACKNOWLEDGEMENT OF RECEIPT OF THE MASTERCARD <br /> PURCHASE CARD <br /> I acknowledge that, on the date indicated below, I received my Purchase Card. I have previously received <br /> a copy of the procedure manual explaining the use and responsibilities of the Purchase Card. <br /> I understand that: <br /> The Purchase Card is a cost - effective method for the purchase and payment of small dollar <br /> material transactions and is limited to $ per month. <br /> The Purchase Card is to be used solely for business purchases; not personal purchases. <br /> I am responsible for reconciling monthly statements and maintaining accurate accounting <br /> records. <br /> Should my employment with City of Centerville terminate, I am responsible for returning the <br /> Purchase Card to the Program Card Administrator. <br /> Employee Signature <br /> Employee Name <br /> (Please Print) <br /> Date: <br /> Please return this form to (Finance Director) <br /> 12 <br /> 28 <br />