Department:______________________________ Cardholder:________________________________
Date of Request: __________________________ Purchasing Card No.:_________________________
Please charge the following department(s) for goods and/or service procured on the purchasing card listed above.
Merchant/ Date of FIS Account Change to
Vendor charge originally charged FIS Account Amount Explanation
Note: Attached copy of Visa Bill for supporting documentation. Approved:
Attach copy of ledger, if applicable.
(Return completed and signed form to Comptroller's Office)
Louisiana Tech University
Transfer of Purchasing Card Charges
Department Head or P. I. of account being charged
(revised 5/1/02)
University Research