PEX Card Application & Agreement
All questions require answers
First and Last Name *
Your answer
Email Address *
Your answer
Street Address, including City, State & Zip/Postal Code *
Your answer
Phone Number, Including Area Code *
Your answer
Your Date of Birth *
Please use "mm/dd/yyyy" format. This information is required by our vendor and will not be shared
Your answer
What Chapter(s) or Bridge(s) will you be making purchases for using the card? *
Your answer
Have you signed an agreement as a Chapter Leader in the past year? *
How soon do you need the card? *
Approval usually occurs within a day or two, but allow a week to be on the safe side. Select which shipping option you want. Fees are subtracted from your Chapter or Bridge balance.
By applying for the PEX Card for my chapter, I agree that I will never share my card number and I agree to use the card issued to me by Bridge Foundry ONLY for approved expenses in support of the Bridge Foundry mission of increasing diversity in the development community. I also agree to submit scans of receipts to finance@schoolfactory.org within 5 days of the end of the month when the charge was incurred, and understand that failure to do so or misuse of funds may result in the revocation of PEX Card privileges. *
Examples: Installfest refreshments/pizza, Breakfast/lunch, USB drives, Nametags, pens, stickers & misc supplies
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Bridge Foundry. Report Abuse - Terms of Service