Campus Card Operations – Copy Card Request

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, Financial Aid Building, Rm 133 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) _____________________________

Please print and fax to (985) 549-5918 or scan and email to [email protected].
Questions? Call Campus Card Operations at (985) 549-3990.