ReasonforRequest:
NewIndexName
IfNameChange:OldName
Department SourceofRevenue:
ContactPerson
Phone#
Check all that apply: Director of Financial Services
N
ew
i
n
d
ex
#
N
ew
f
un
d
#
N
ew
D
ept
(O
rg
)

#
Signature Date
Expected length of time that this account will be in use:
Lessthan2years
25years
Vice Chancellor of Finance & Administration
Over5years
Signature Date
For Business Office use only
Notes:
In
d
ex#
Rev.Acct.
Fund#
FundType
Org#
Eff.Date
P
rogram
SetupDate
New Index/Fund Request Form
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