CMU Business Card Authorization Log

Central Michigan University
Credit Card Services
204 Warriner Hall
Phone: (989) 774-3481
Fax: (989) 774-1069
Date: 
 
This authorization log should be maintained by the cardholder and kept on file in the using department.  This form does not get copied to any other department.

Cardholder
First Name:       Last Name:        
Card Number: (Last 4 Digits)
Department:

Other CMU employees authorized to use my card
Name Date Authorized Date Revoked
__________________________________________________
  Print name/       Signature		 __________ __________
__________________________________________________
  Print name/       Signature		 __________ __________
__________________________________________________
  Print name/       Signature		 __________ __________
__________________________________________________
  Print name/       Signature		 __________ __________
__________________________________________________
  Print name/       Signature		 __________ __________
__________________________________________________
  Print name/       Signature		 __________ __________
The CMU Business card is intended for use by the named Cardholder. Should the Cardholder authorize another employee to use the card, the Cardholder is responsible for making certain that other users are properly trained. The Authorization Log should be maintained at the office site of the Cardholder.