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					                                                     Chancellor's Office
                                          Procurement Card Sign-Out and Activity Log


                                                                                XXXX - XXXX - XXXX -
Department                                 Index                                Procurement Card Number - last 4 digits


Card Custodian                                                                  Expiration Date

     Date          User's Signature                                                                                   On Stmt
                                                                          Description                    Amount
 Out     Ret'd                        Vendor Name                                                                      Dated




Department Record Copy
Updated 12/17/07

				
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