Procurement and Contract Services
July 2018
I agree to all terms of the travel card program and authorize US Bank to proceed with my application for credit.
Applicant Signature:__________________________________________ Date: _________
Approvals:
Traveler’s Dean/Manager (or Designee):__________________________________ Date: _________
Division Cabinet Member or Designee: _________________________________ D
ate:
________
CSU Channel Islands
U.S Bank Personal Liability Travel Card Application
RETURN ORIGINAL COMPLETED FORM
T
O:
Procurement
Office
This form is to be completed by CSUCI faculty or full time staff interested in securing a US Bank
Visa Personal Liability Travel Card for payment of reimbursable university-related travel expenses
when travelling with students. By submitting this application, US Bank will perform a credit check, to
determine issuance of cards by applicant’s creditworthiness.
Please complete the following information for each card requested. The cardholder’s name will appear
on the credit card exactly the way it reads on this form.
Cardholder Information
Name: Social Security Number:
Home Address:
Home/Cell Phone: Email Address:
Job Title:
Employee ID:
Department Name:
Work Phone:
Credit Limit Requested $
1. Employee Applicant agrees to be bound by the US Bank Cardholder Agreement accompanying the card for all charges incurred by the use
of the card or the related account. US Bank may obtain credit information concerning Employee Applicant for the sole purpose of issuance,
renewal and/or replacement of the US Bank Corporate Card.
2. Employee Applicant has read and agrees to the CSUCI Personal Liability Travel Card Procedures.
3. Employee Applicant understands that this card will be used for official business travel incidental charges only (e.g. taxi or bus fares,
meals, gas, parking fees) and is responsible for making all payments to US Bank upon receipt of monthly statement.
4. By enrolling in the US Bank Corporate Card Program you are authorizing the Program Administrator to verify charges in relation to
official business travel. If the charge card contains personal charges, it may be terminated.
5. The University will not reimburse the cardholder for any interest charges.
Please be advised that your Social Security number will be provided to US Bank.
