Costco Purchasing Card

BETHEL SCHOOL DISTRICT TRAVEL CARD REQUEST

______Date of Request Requester Name & Ext. # (Please Print) ______Program Purchase Amount Requested

______Administrator’s Signature Date Student Signature Date (For ASB Expenditure Authorization)

*(Note: When an Expenditure Authorization Form (EAF) has been approved by the administrator (and student, for ASB ) and the EAF is attached to this form, the signature line(s) for the administrator (and student, for ASB) can state “See Attached”.)

Board Approval Date: ______Airlines: ______

Travel Departure Date: ______Travel Return Date: ______

Destination: ______

Name(s) of Traveler(s): Account Code(s): ______

______

(Please attach a list with the names and account codes for additional travelers).

TRAVEL CARD AGREEMENT

1. Prior approval for out-of state-travel has been obtained for all travelers listed above.

2. Traveler(s) agrees to be responsible for the excess expenditures if the limits of budget authority are exceeded.

3. Traveler(s) agrees not to use the card for personal use or for any other non-district purposes.

4. Traveler(s) acknowledges use of the travel card by other individuals or for travel not listed above is prohibited.

5. Traveler(s) agrees to use the card for airline or airline, hotel, and rental car package reservations only.

6. Traveler(s) agrees to return all credit slips and corresponding receipts to the card custodian the day after purchase and to promptly complete any district forms required.

7. Traveler(s) does hereby certify under penalty of perjury, that the materials furnished, services rendered, expense incurred, or other item of indebtedness as evidenced on the attached receipts are true and correct charges against Bethel School District #403; that the claim is just and due; that no part of the same has been paid; and that I am authorized to sign for the Travel Purchasing Card.

______Requester’s Signature Business Office Signature

______

Word/Bus on FS2/Bus Ofc/Forms (Revised 03-11-16) Date Date

Word/Bus on FS2/Bus Ofc/Forms (Revised 03-11-16)