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 ______________________


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.