P-Card Management & Exception Request Form Template: Controls

P-Card Management & Exception Request Form Template

Company Name: [Company Name]

Department: [Department Name]

Form Date: [Date]

Reference Number: [Reference Number, if applicable]

1. Request Type

This request relates to:

☐ temporary spending limit increase

☐ restricted or unusual purchase request

☐ merchant category exception

☐ emergency purchase approval

☐ late receipt or missing documentation

☐ cardholder account update

☐ other exception: [Describe]

2. Cardholder Information

Cardholder Name: [Full Name]

Job Title: [Job Title]

Department: [Department Name]

Employee ID: [ID Number, if applicable]

P-Card Last Four Digits: [XXXX]

Manager Name: [Manager Full Name]

3. Transaction or Request Details

Vendor Name: [Vendor Name]

Transaction Date: [Date, if applicable]

Requested Amount: [$Amount]

Current Card Limit: [$Amount]

Requested New Limit, if applicable: [$Amount]

Description of purchase, issue, or requested exception:

[Insert details]

4. Business Purpose

Business reason for this request:

[Explain why the transaction or exception is needed]

How this request supports business operations:

[Insert explanation]

5. Policy Exception Details

Relevant policy rule, limit, or restriction:

[Insert policy section, rule name, or internal guideline]

Reason the exception is being requested:

[Insert reason]

Has this issue or exception occurred before?

☐ yes

☐ no

If yes, explain:

6. Supporting Documentation

The following documents are attached or available for review:

☐ quote or invoice

☐ receipt

☐ vendor explanation

☐ manager email approval

☐ budget confirmation

☐ policy reference

☐ other: [Describe]

7. Risk and Impact Review

Potential impact or risk related to this request:

☐ low

☐ moderate

☐ high

Additional notes regarding compliance, audit, budget, or vendor concerns:

[Insert notes]

8. Manager Review

Manager Decision:

☐ approve

☐ deny

☐ approve with conditions

Manager comments:

[Insert comments]

Manager Signature: __________________________

Name: [Manager Full Name]

Date: [Date]

9. Finance / Procurement / Compliance Review

Reviewed by: [Full Name]

Department: [Finance / Procurement / Compliance / Other]

Review Decision:

☐ approved

☐ denied

☐ additional information required

☐ escalated for further review

Review comments or conditions:

Signature: __________________________

Name: [Full Name]

Date: [Date]

10. Final Decision

Final Status:

☐ approved

☐ denied

☐ approved with restrictions

☐ pending further documentation

Effective date of decision: [Date]

Special conditions, follow-up steps, or expiration date of exception:

11. Cardholder Acknowledgment

I understand that any approved exception applies only as stated in this form and does not change the company’s general P-Card policy unless confirmed separately in writing.

Cardholder Signature: __________________________

Name: [Cardholder Full Name]

Date: [Date]

12. Recordkeeping Notes

Internal notes, tracking comments, or audit reference: