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) _____________________________