Southeastern Louisiana University

Copy Card Request Form

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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          Requisition #:
     (You must submit a purchase order for cost of replacement card with this form)

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 _________________________________________

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LION'S LAGNIAPPE 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 _____________________________________________

Print Name ____________________________________________