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<br />SAAE COMPLETED FORM ~RA <br /> <br />City of La Porte, Texas <br />CREDIT CARD REQUEST AND AUTHORIZATION <br /> <br />Employee/Official Name: John Edward Doe <br /> <br />Position/Title: Director of Public Information <br /> <br />Authorized Limit: $2,500.00 <br /> <br />Date of Request: November 1,2002 <br /> <br />Cardholder Acknowledgement <br /> <br />I hereby acknowledge receipt of the City of La Porte written Credit Card <br />Policy, and certify that it has been reviewed with me. I understand that by <br />accepting this card, I am aware that it is to be used ONLY for the purposes of <br />official business for the City of La Porte and I accept full responsibility for its <br />safekeeping, I further agree to abide by the City of La Porte Credit Card <br />Policy and Procedures Manual, and understand that I may be personally liable <br />for any unauthorized charges made by me and agree that any such charges <br />may be deducted from my paycheck. <br /> <br />Prospective CardllOlder <br /> <br />Date <br /> <br />Authorizing Officer (City Manager) <br /> <br />Audit Committee Approval <br /> <br />Department Approving Official <br /> <br />Program Administrator Approval <br /> <br />Date Request Processed <br />Date Card Issued <br /> <br />Finance FonnCCRA <br />11/01/02 <br /> <br />12 <br />