Department Name: Budget Unit No: Phone Ext: Faculty Box: Name Card Issued to: PLEASE CHECK THE APPROPRIATE BOXES: (please check only one box)
Reactivate copy card number Deactivate copy card number
Issue new card (You must check appropriate box for limit)
With limit of $ Without limit
***Copy cards may ONLY be picked up by Dept.Head, Secretary, or Person to whom the card is issued to***
Department is responsible for all copies made on lost/stolen copy cards until this form is received requesting deactivation. There is a $15.00 charge for replacement of lost/stolen copy cards. Please submit this form to the Campus Card Operations office located in North Campus Main Building Room 223 or fax to 549-5918.
Department Head Signature _________________________________________
Card Number Assigned __________________________ Sequence Number _______________________
Previous Credit Limit ___________________________ New Credit Limit _________________________
Comments _________________________________________________________________________
Employee Signature ______________________________________________
Verified By Signature _____________________________________________
Card Received by: Signature _____________________________________________ Date _________________
Print Name ____________________________________________ W __________________ Status (Employee, GA, Student Assistant) _____________________________
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