I, ___________________________________, hereby request an American Express Corporate Purchasing Card. As a Cardholder, I agree to comply with the following terms and conditions regarding my use of the Card.

1. I understand that I am being entrusted with a valuable purchasing tool and will be making financial commitments on behalf of my agency and will strive to obtain the best value for the agency by using "preferred suppliers" as identified by the Agency's Purchasing Department.

2. I understand that my agency is liable to American Express for all authorized charges made on the Card.

3. I agree to use this Card for approved purchases only and agree not to charge personal purchases. I understand that my agency will review the use of this Card and the related management reports and take appropriate action on any discrepancies.

4. I will follow the established procedures for the use of the Card. Failure to do so may result in either revocation of my privileges or other disciplinary actions, including termination of employment.

5. I agree to return the Card immediately upon request or upon termination of employment (including retirement). Should there be any organizational change that causes my cost center to change, I also agree to return my Card and arrange for a new one, if appropriate.

6. If the Card is lost or stolen, I agree to notify the Program Administrator and American Express immediately.