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.