Full Name (Card User)
    (Legal Name - Must Match Driver's License)




    Account Number (card number)

    I have received the corporate credit card indicated above. I take responsibility for all expenses charged to this credit card and I agree to the following:

    Responsibility (Yes/No)
    The card user understands they bear ultimate responsibility for the card and all charges, expenses, etc.

    Agree to Use (Yes/No)
    Use of the corporate credit card is for business-related travel, meals, hotels, car rentals and other business-related expenses only. Personal expenses may not be charged to the corporate credit card. The card will not be used to withdraw cash.

    Reports (Yes/No)
    All expenses and charges to the corporate credit card must be submitted each month included in a monthly expense report which explains all charges on your monthly statement.

    Misuse and Reconciliation (Yes/No)
    If there is any misuse of the card or card user fails to reconcile expenditures within the prescribed procedures and timeframe, card user authorizes the company to recover funds through payroll deductions for any amounts incorrectly claimed, or for un-reconciled amounts, or for reconciliations that are one month in arrears of the statement date.

    Signature (Must be legible and match name above)
    "My signature below confirms my agreement to the terms presented and I have read, understand and agree to the above-mentioned terms governing the use of a corporate credit card for LaSorsa and Associates. I understand misuse, abuse or negligent use of this credit card or willful violation of the terms of this agreement may result in personal financial liability and disciplinary action, including discharge from the company."