Revised 10/2017
Cardholder Application
Please note: Applications for Students Require a "Student Application Form"
One Card Program
Cardholder Information
Cardholder Name:
Office Location:
Campus Phone:
Campus Email:
Card Defaults
Cycle Credit Limit:
Single Purchase Limit:
(Max $20,000)
(Max $4,500)
Event Card Exception:_______ (Yes/No)
Expectations of Cardholder
Please review the One Card handbook for appropriate uses. Specific procedures regarding One Card Applicants include but
are not limited to:
Appropriate Uses:
Only used for authorized expenditures
Expenditures will be made to benefit the School
Inappropriate Uses:
Personal Transactions
Transactions not authorized by Approving Official
Other Requirements:
All required documentation will be included in an expense report in TEM and submitted to the
Approving Official in a timely matter
One Card must be surrendered to your Approving Official when employment is terminated
Cardholder Acknowledgment & Certification of Signature
I understand that I am permitted to make only those purchases that are in compliance with the School's policies and procedures
including but not limited to:
Financial Policies
Procurement Rules
Direct Charge Policies
I also understand that the One Card is the property of the Colorado School of Mines, assigned to me by my Department and that at any
time my Department Head or the One Card Administrator can decide that I no longer may use the card. I also understand that before I
will be given the One Card I must complete a training given by the One Card Administrator.
Cardholder Signature
Approving Officials' Signature
Approving Officials' Printed Name
For Official Use Only
Date Submitted to

the Bank: