dept_card_authority_form

							                                                                       3940077f-2463-4756-8e1e-a0e7d77a15f3.xls

                                                                Department Card Authority Form
                            Card/Dept. Details                                                  Requested Function                                               Account Details
                                     Student/Staff
                                                   U-Bix Card   No of New   Issue New    Convert ID to     Withdraw         Add       Amount or
      Surname, First names               Card                                                                                                             Dept. A/C to charge (or New A/C)
                                                    NUMBER      U-BixCard   U-Bix Card    Dept Card          Card          Money      Credit Limit
                                     USERNAME


(EXAMPLE)       BLOGG, JOE           BLOJO123           45678                                                                         $          10              GL 10TH C01 3111 00




                                                    Signed
                                                    HOD or
                                                   delegated
Department:                                                                                                                                                         Date:
                                                     Auth.                                                Extension:                                                                    /   /2011


                                                                                         Email the completed form to uniprintshop@otago.ac.nz from the University email
Any queries to Uniprintshop (4068)                                                       address of someone with the appropriate authority or sign and fax to 4061.
                                                                                         This form can be directly downloaded at http://www.library.otago.ac.nz/services/copying.html