ON – Purchase Card Application – Non-Unit Cardholder InformationSelect Type* Administrative Community Leader (ACL) Event Employee - Property Employee - Camp Program Staff Employee - Ontario Council LPESC Other Department*AccountingCamping and Outdoor ExperiencesCommunity PlanningCookiesEventsFinanceHuman ResourcesITMarketing and CommunicationsMember AdministrationOperationsUnit BankingUnit SupportEvent name* PropertyAdelaideAdemacBonita GlenBryerswoodCarruther's PointConestogoDoe LakeKah-Ne-DoKienukaMa Kee WaMississauga Guide HouseOrendaPiper's HillTekaTewatenoTRHACWindsor Guide HouseWoolseyWyokaYour Community*N/AProvincial13456789101314151617181921222324252728293031323435363738404199Cardholder Name* First Last iMIS Number Title/Position* Title/Position* Title/Position* Title/Position* Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Daytime Phone Number*Email Address* Cardholder Certification I understand that the VISA Purchase Card is to be used for expenses in relation to the above stated position. I am responsible for retaining all purchase card receipts and completing and submitting the monthly Purchase Card Transactions Record along with itemized receipts within five business days of receipt. In the event that the card is lost or stolen, I will immediately notify US Bank Canada at 1-800-588-8067 and the Purchase Card Administrator at 1-877-323-4545 ext. 2409 or purchasecard.admin@guidesontario.org. Misuse of the card or repeated violations of Ontario Council’s policies may result in the suspension or cancellation of my card, and or other disciplinary action up to and including termination for cause. If there are any outstanding personal expenses on my corporate card when my employment ends for whatever reason, I hereby authorize Girl Guides of Canada, Ontario Council to deduct the outstanding balance from any wages, termination pay and/or severance pay owing to me. The foregoing constitutes a written authorization within the meaning of section 13(3) of the Employment Standards Act, 2000. The following are examples of misuse and policy violations: Purchase of items or services for personal use Purchase of items or services over and above the limitations set by your Manager and Ontario Council Use of the card by anyone other than the authorized cardholder Failure to retain receipts and to submit them along with the Transactions Records on a monthly basis (Refer to the Purchase Card Transactions Record Instructions for more information) I agree to the terms above and I certify that the information I provided is current and accurate.Cardholder Certification I understand that the VISA Purchase Card is to be used for expenses in relation to the above stated position. I am responsible for retaining all purchase card receipts and completing and submitting the monthly Purchase Card Transactions Record along with itemized receipts within five business days of receipt. In the event that the card is lost or stolen, I will immediately notify US Bank Canada at 1-800-588-8067 and the Purchase Card Administrator at 1-877-323-4545 ext. 2409 or purchasecard.admin@guidesontario.org.Cardholder Signature* Please type your full name in this space to confirm your agreement to the statement above.Date* MM slash DD slash YYYY CAPTCHA