Close Account(s) Request Form
Cardholder and/or PVS Net Accountholder

Use this form to terminate an account for an employee who is leaving the University and/or no longer needs the account in his or her name.  After completing this form, please mail it to 204 Warriner Hall or fax it to Cindy Smith or Sara Yonkey at (989) 774-1069.
 

Section 1:  Terminating Employee Information

First Name:       Last Name:   
Phone Number:       Fax Number:
Global ID / Email: @cmich.edu
 
Reason for Change:
Leaving the University    Changing Departments   Other
Date to Terminate: (please do not back date)
 

Section 2:  Please enter all credit card accounts to be closed

CMU Business Card Number
(Last 4 digits)
PVS Net Acct - Log In UserName ID:

Section 3: This form is being submitted by whom

Today's Date:
Your First Name:       Last Name:   
Phone Number:       Fax Number:
Campus Email: @cmich.edu

Section 4: Signatures


 
_______________________________________               ___________________
Signature                                                                         Date