Campus Card Operations

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Campus Card Operations - Copy Card Request Form

Department Name:     

Budget Unit No:         

Phone Ext:                 

Faculty Box:               

Name Card Issued to:  

PLEASE CHECK THE APPROPRIATE BOXES: (please check only one box)

Replenish Copies to copy card number Amount: $

Replace lost/stolen copy card number

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 _________________________________________

PRINT NAME _____________________________________ DATE ______________________

CAMPUS CARD OPERATIONS OFFICE USE ONLY Date Completed _________________________________

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) _____________________________

Southeastern Louisiana University

Campus Card Operations - Copy Card Request Form

Campus Card Operations