Fillable PC Cancellation (Southeast Missouri State University)

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PC Cancellation (Southeast Missouri State University)

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Card Cancellation Form
FRD : 04/27/18
FCD : 03/4/2014
FOR USE BY ACCOUNTS PAYABLE OFFICE ONLY
SEND COMPLETED FORM TO: Accounts Payable MS3250
Cardholder Signature: Date:
Form Received:
Date Closed:
Cardholder Name: Southeast ID:
This form should not be used for Lost/Stolen Cards or Expired Cards that have been renewed.
Please shred the card in these cases.
This form verifies that the employee whose name is mentioned above has relinquished possession of their University Purchasing
Card and all transactions have been reconciled and submitted.
Attached are the cut-up pieces of the Purchasing Card assigned to this individual in accordance with Southeast Missouri State
University's Policy and Procedures.
Tape Half of
Card Here
Tape Half of
Card Here
Supervisor Signature: Date:
Additional Notes:
Closed by:
Last 4 digits on card:
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PC Cancellation (Southeast Missouri State University)

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Completed 26 July 2020

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