Cardholder Setup Form Government Services 

Travel 

Select one:

 8201 (Visa)

 8202 (Mastercard) 

Card setup: 

Regular 

Expedite 

Card delivery: 

Regular 

Overnight 

Date of travel 

Please return 

completed 

form via: 

Email: cpsappsgsa@usbank.com 

Fax: 612.973.3791 or 800.974.0777 

Mail: U.S. Bank Government Services 

200 South Sixth Street 

EP-MN-L25C 

Minneapolis, MN 55402 

Issue plastic:

 Yes

 No 

Ship to: 

Mailing address 

Alternate address 

Required cardholder information Required cardholder legal information 

Applicant/Cardholder name: Full legal name: 

(maximum 21 characters) (maximum 78 characters) 

Address 1: Residency address 1: 

(maximum 35 characters) (Cannot be PO Box) (maximum 35 characters) 

Address 2: Residency address 2: 

(optional) (maximum 35 characters) (optional) (maximum 35 characters) 

City: ___________________________________ State: ___________ City: ___________________________________ State: ___________ (maximum 35 characters) (maximum 2 characters) (maximum 35 characters) (maximum 2 characters) 

ZIP code: __________________ Country: ____________________ ZIP code: __________________ Country: ____________________ (maximum 9 char.) (maximum 3 characters) (maximum 9 char.) (maximum 3 characters) 

Social security number: Date of birth: 

(optional) 

Agency/Organization name: 

(name 2) (embossed on plastic – maximum 21 characters) Alternate delivery address 

Business phone number: Address 1: 

(maximum 10 characters) (maximum 35 characters) 

Mobile phone number: Address 2: 

(maximum 18 characters) (maximum 35 characters) 

Fax number: City: ___________________________________ State: ___________ (maximum 18 characters) (maximum 35 characters) (maximum 2 characters) 

Email address: ZIP code: __________________ Country: ____________________ (maximum 60 characters) (max. 9 char.) (maximum 3 characters) 

Processing levels 

Agent number: ____________ Company number: ____________ Division number: __________ Department number: ___________ 

Reporting levels 

Level 1: ______ Level 2: ______ Level 3: ______ Level 4: ______ Level 5: ______ Level 6: ______ Level 7: ______ 

Credit limit Cash limit MCCG 

Standard: _________________ Standard: _________________ Standard: _________________ 

Restricted: _________________ Restricted: _________________ Other: _________________ 

Cardholder/Applicant understanding/signature: 

Creditor is U.S. Bank National Association. Applicant understands that this card is A. I authorize U.S. Bank to obtain credit information in 

to be used for offcial travel related expenses. Applicant understands that the U.S. 

Bank billing statement is due and payable in full upon receipt. Applicant understands connection with this application. that he/she is liable to U.S. Bank for full payment of all purchases authorized by 

applicant, independent of any agreement or program for reimbursement that B. I do not authorize U.S. Bank to obtain credit information. 

may exist between applicant and agency/organization. Information on delinquent 

accounts may be furnished to consumer reporting agencies or others who may 

properly receive that information and you consent to the foregoing. 

Applicant acknowledges that all information provided herein is __________________________________________________________ 

true and correct. Applicant signature Date 

Submitted by A/OPC: 

Name (print/type): _______________________________________________________________________________________________________ 

Phone: _____________________ Fax: ______________________ Signature: _______________________________________________ 

Email: ___________________________________________________ Date submitted: __________________________________________ 

©2019 U.S. Bank. U.S. Bank Government Services is a division of U.S. Bank National Association. This publication is neither paid for, sponsored by, nor Customer service implies endorsement, in whole or in part, by any element of the United States Government. The information provided is for general use only. Contact the GSA 

Contracting Offce with any questions related to proper use of the master contract. Printed in the USA. 888.994.6722 01-0027-01-CSF-TR (7/19) CAT-16974293