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.
Approved:
Approved:
(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
Dean
(revised 5/1/02)
University Research
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