Budget Unit No:
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 $
***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 _________________________________________
Card Number Assigned __________________________ Sequence Number _______________________
Previous Credit Limit ___________________________ New Credit
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@example.com.
Questions? Call Campus Card Operations at (985) 549-3990.