Credit Card Acknowledgement Form

Cardholders are required to sign this agreement indicating their acceptance of the following
policies and procedures. Individuals who do not adhere to these policies and procedures will risk
revocation of their credit card privileges and/or disciplinary action.

By signing this form, you acknowledge that you have received a DNB Company Credit Card with
the last 4_________________, expiring_________________.

Policies & Procedures:

 Company purchases only, No personal purchases
 Truck # and Mileage written on receipts
 Job #s and PO#s on ALL Receipts
 Notification of accidental purchases must be made to supervisors immediately and the charges will
be payroll deducted

All Company credit cards are to be turned in Immediately upon termination.

________________________________________________________ _____________________________________________
Employee Signature Date Issued Witness Date

________________________________________________________ _____________________________________________
Employee Signature Date Returned Witness Date

_______________________________________________________ _____________________________________________
Returned to & Shredded by Date Witness Date

______________________________________________________
Employee Name (Printed)

Office: 803-739-2694
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