Citidirect Access Application s2

Instructions:
CPMs/APCs complete this form to report issues with Centrally Billed Accounts (CBAs). Please Type or Print the information. Note: New applications will be available on Nov. 10 at http://www.citimanager.com/dodhome. Citi will continue receiving periodic updates from your current provider through Nov. 14. New accounts and existing account updates will be captured through November 14 and new Citi cards will be mailed if applicable.. *Indicates required field. Please TYPE or PRINT information.
1. Fax completed form to the Citi Card Deployment team
2. Maintain copy for CPM / APC file / Date:
Attention: / Citi Card Deployment Team
Fax: / 757-857-0894 OR 757-857-0895
Toll Free: 866-951-8005
Collect: 757-818-6893
Section I: Central Account Information
Transaction Account Type*: / White Plastic
Unit Card / Agency*: / Army Navy Air Force Marine Corps Independent
Citi Account Number*: / Please provide the last 12 digits of the Citi account number using the crosswalk spreadsheet provided to you by your service CPM
x / x / x / x
Section II: Card Receipt Information
Reason for Reissue* / Card Not Received Card Destroyed In Error Card Name Incorrect Card Address Incorrect
Information to be Updated / Only enter information to be changed as it relates to the card. Card name changes can only be made for the white plastics.
Card Name:
Attention:
Address Line 1:
Address Line 2:
City: / State: / Zip/Postal Code:
Country:
Commercial Phone: / Commercial Fax:
Delivery Method* / If no selection is made from the options below, the card will be mailed standard delivery
Standard Expedited ($20 delivery fee)
Section III: Account Closure Information
Close Account: / Complete this section when closing an account ONLY.
Yes / If closing a Unit Card account, indicate the reason for closure:
APC Request Cardholder Deceased Cardholder no longer employed
Section IV: Additional Details
Additional Details:
Section V: Authorization
APC / CPM Information*:
/ The individual completing this form must be an APC or CPM.
Print or type Name and Title / Business Phone (Commercial Access Number Required – / Ext.
Signature / Date

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CB087DoD 1 of 2

Instructions Sheet
Purpose: / APCs / CPMs complete this form to report Department of Defense Centrally Billed Travel Cards that were not received, need to be closed, or to report a change. All fields marked with an asterisk (*) are required.
Instructions: / Who: / This form is to be completed by the Agency Program Manager (APC) or the Component Program Manager (CPM).
When: / Complete this form when there is a need to report a card reissued, closed or to report a change.
How: / Section I: / Central Account Information
· Transaction Account Type (required): Indicate if the card is a white plastic (previously a cardless transaction account) or a unit card
· Agency (required): Indicate the agency to which the card is assigned
Section II: / Card Receipt Information
· Reason for Reissue (required): Select the best option
· Information to be updated: Provide the information to be changed as it relates to the card. Card name changes can only be made for the white plastics.
· Address (lines 1 & 2), City, State, Zip/Postal Code & Country: Enter the complete address to where the new plastic should be mailed. Use the additional details section to provide any additional information (i.e., if the billing address is different).
· Delivery Method (required): select the best option.
Section III: / Account Closure Information
· Close Account: Only complete if you want to close an account. For unit cards please indicate the reason for the closure.
Section IV: / Additional Details
· Additional Details: Please provide any additional information we need to complete your request.
Section V: / Authorization:
· Print or Type: Enter name (print or type) and title of APC / CPM completing this form
· Business Phone: Enter the APC / CPM commercially accessible business telephone numbers, including area / country code and extension, if applicable
· Signature: APC / CPM signature
· Date: Enter the date the form is signed by APC / CPM
Submit Request form with supporting documentation via fax to:
Attention: Citi Card Deployment Team
Fax Numbers:
757-857-0894 OR 757-857-0895
Toll Free: 866-951-8005
Collect: 757-818-6893

Global Transaction Services

CB087DoD 1 of 2