PUR 2.10 (4/91)

TO:   Director of Purchasing Services              Date: _____/_____/_____

Department: ______________________________  Account No:____________________

Individual Responsible for the Cards: _____________________________________                                                      ^{Name                                    Ext.}

          Petroleum Company                       No. of Cards Needed __________________________________       ______________ __________________________________       ______________ __________________________________       ______________

Reason for Necessity of Card:

______________________________________________     ______/_____/_____
Department Head:  Name/Title                              Date

______________________________________________     ______/_____/_____
Vice Chancellor:  Name/Title                              Date

______________________________________________     ______/_____/_____
Vice Chancellor for Business Affairs                      Date

• Department head routes form to appropriate Vice Chancellor for approval and then to Vice Chancellor for Business Affairs for final approval.
• The Vice Chancellor for Business Affairs will route form to the Director of Purchasing Services upon final approval.