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

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 ______________________

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.