Request for Prepaid Departmental Copy Card

Please fill out this form to receive a departmental photocopy card.
This card will enable you to use the card-operated photocopiers in Kent Library at the copiers in the Periodicals section.
Departmental Copy Cards are for use in official University business only.
Please complete this form and return it to the Information Technology Help Desk located in Memorial Hall (Room 107). Cards may also be picked up at the Help Desk.
Name of Department: ______________________________
Number of cards requested:
( $2.50 per card )
______________________________
Total for cards purchased: ______________________________
Number of copies per card:
( $0.10 per copy )
______________________________
Total amount including cards and copies: ______________________________
Bill to account number: ______________________________
Authorized Signature: ______________________________
Card(s) Received by: ______________________________
Date: ______________________________

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