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 purchase requisition with this form to the Lion's Lagniappe Office located in the Student Union, Room 113, 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 _____________________________________________
Print Name ____________________________________________