Fillable Printable Wells Fargo Application Form
Fillable Printable Wells Fargo Application Form
Wells Fargo Application Form
WELLS FARGO ONE CARD PROGRAM
CARD ACCOUNT APPLICATION AND MAINTENANCE FORM
INSTRUCTIONS FOR COMPLETING THIS FORM
PLEASE TYPE FORM, EXCEPT SIGNATURES
SECTION 1
Type of request: Please select one option and complete fields as necessary. Please note that all accounts must
have an Executive Director or higher level of approval.
1.1 New Account: Regular or Declining Balance
Regular - A regular VISA card is issued with a monthly credit balance that renews at the close of every
billing cycle.
Declining Balance Card - A VISA card is issued with a maximum amount that may be spent within a
specific time period. The amount does not renew at the close of each monthly cycle. Once the ending
date arrives or the amount is used, the card is closed. These would typically be used in place of a cash
advance.
1.2 Change to Account - this would apply to any change to the application (reconciler, approver,
secondary approver, credit limit, account number)
1.3 Account Closure - When a cardholder is no longer with the University. Please turn in credit
card to Human Resources. They will then notify Accounts Payable regarding the account
closure.
SECTION 2
2.1 If box 1.2 was marked in Section 1, please fill in last 8 digits of credit card information.
2.2 If box 1.2 was marked in Section 1, please fill in name as shown on credit card.
SECTION 3
3.1 Name to appear on card: Please give name as it appears on your identification card used
for verification.
3.2 Email address: Preferably an APU email address but should be the address to where you frequently
review your emails. All correspondence from Accounts Payable and Wells Fargo will be sent to you
via email including monthly statement notification.
3.3 Job title: Current position title at APU.
3.4 Last 5 digits of Social Security Number: Required by Wells Fargo as verification on your account.
3.5 Department Name: Please give your current department name
3.6 Department account #: 7 digits required only (fund & department) if account starts with 15 or 16, please
Add 5 digit project number.
3.7 Reconciler name/email/SS#: You may choose your administrative assistant or other employee to
serve as the person to reconcile your monthly statement on-line. Otherwise, you will be the only
person allowed to access and reconcile your statement on a monthly basis. Both the cardholder and
reconciler will have access to the account.
Please complete the "Reason for Request" for the Wells Fargo One Card Program on the application.
Forms received without this information will be returned.
3.9 Secondary approver /email/SS#: Please indicate your next level of approval should your immediate
supervisor be unavailable to approve these transactions on-line. A secondary approver is now
required in order to process the Wells Fargo card account application.
SECTION 4
4.1 Regular card credit limit: Request the desired amount that could possibly be spent in one month.
4.2 Regular card single transaction limit: Request the desired amount for a single transaction. The purpose
would be if the manager would like another form of security on the card.
4.3 Maximum transactions per day: This is optional if you would like to set a limit of how many times
the card may be used in one day.
4.4 Maximum dollar spent per day: This is optional
4.5 Declining balance card amount: This amount will reduce as monies are spent and will not renew.
4.6 Declining balance card end date: The date this card should expire.
SECTION 5
5.1 Employee cardholder signature: By signing this application you are indicating your desire to hold a VISA
credit card issued to you by APU and Wells Fargo Bank. Please know that this card account will not be
connected to your personal credit history, but you will be required to attend training and adhere to the
policies and procedures for the use of this card as it will be university property.
5.2 Cardholder's Supervisor signature and title: Your direct supervisor must approve of this request.
5.3 The Executive Leadership Team has established that each request must have an approval from one of
these levels: Executive Director, Dean, Vice-Provost, Vice-President or President
5.4 The Executive Director of Finance will give the final review and approval on all requests before
processed by the Program Administrator.
If you need cash access, please contact your program administrator to discuss the process for this request.
PRINT FORM AND EITHER CAMPUS MAIL OR FAX TO ACCOUNTS PAYABLE AT (626) 633-9147
APPROPRIATE SIGNATURES MUST BE COMPLETED
3.8 Approver name/email/SS#: Please indicate your budget manager/supervisor name and email
address to which your statement will be sent for approval.
Wells Fargo One Card Program
Card Account Application and Maintenance Form
PLEASE SEE INSTRUCTIONS ON PAGE 2 - ALL ITEMS MUST BE COMPLETED
SECTION 1: TYPE OF REQUEST (CHOOSE ONE)
1.1 New Account: (complete section 3, 4 & 5)
1.2 Change to Account: (complete sections 2 and section 3 or 4 depending on what needs to be changed & always section 5 )
Regular Declining Balance
1.3 Account Closure: (please turn in card to Human Resources so they can amend their records)
SECTION 2: FOR CHANGES TO CURRENT ACCOUNTS ONLY:
2.1 Fill in last 8 digits of card account number:
2.2 Fill in current name on card:
SECTION 3: CARDHOLDER & APPROVER INFORMATION
3.1 Name to Appear on card
3.2 Email address
3.3 Job Title
3.4 Last 5 digits of SS Number
3.7 Reconciler Name/Email addr./Last 5 digits of SSN
SECTION 4: CREDIT LIMITS (if you need other limitations, please contact Accounts Payable
4.2 Regular Card Single Transaction Limit
4.1 Regular Card Monthly Cr. Limit
4.4 Maximum Dollar spend Per Day
4.5 Declining Balance Card Amount
4.6 Declining Balance Card End Date
SECTION 5: AUTHORIZATIONS
(Secondary approver required)
5.1 Employee Cardholder Signature
5.2 Cardholder's Supervisor Signature & Title
5.3 Executive director/Dean/VP Level of approval
5.4 Finance Approval
Date
Date
Date
Date
PRINT THIS FORM ONCE COMPLETED AND OBTAIN SIGNATURES. YOU MAY FAX TO BUSINESS OFFICE AT (626) 633-9147
This form is PDF ready, it may be typed or handwritten. SIGNATURES MUST BE COMPLETED
3.5 Department Name
3.6 Department Number
3.8 Approver Name/Email addr./Last 5 digits of SSN
3.9 Secondary Approver Name/Email addr./Last 5 digits of SSN
Print Name
Print Name
Print Name
4.3 Maximum Transactions Per Day
REASON FOR REQUEST:
reconciler, approver, secondary approver, credit limit, account number
Faculty
Staff
Adjunct
Student
Temp
Please check one
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