Fill - Free fillable texas woman's university data card request form PDF form

DataCardRequestForm

Procurementand Contract Services

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Purch asing

JUSTIFICATION

EmployeeName RequestDate

Department

JUSTIFICATION

TYPEOFEQUIPMENT/SERVICE

TypeofCardRequestedandAmount

SelectDataPlan DataPlansAvailable

Price

$ AT&TDataConnectMomentum5G(LTETablet)

$ AT&TDataConnect5GLaptopConnect

$ VerizonWireless4GLTELaptop

$ Other(PleaseSpecify in Box Below)

EffectiveDates:

SourceAccount:

AUTHORIZATION

TheundersignedemployeeresponsiblefortheDataCardrequestherebystatesthatIund erstandtherespo nsibilitiesofmanagingmyData

Card.Thi sformandarequisitionshouldbe submittedto thePurchasingDe partment inorderfortherequestto beprocessed.

EmployeeSignature Date

DepartmentAuthorizedSignature Date

ProvostorViceP

residentSignature Date

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Procurementand Contract Services

P.O.Box425439/BralleyAnnex

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Denton,TX76204‐5439

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P

(940)898‐3812

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F

(940)898‐3519  10/16

**Request a price quote by sending an email to procure@twu.edu before submitting this form**

**Request a price quote by sending an email to Procure@twu.edubefore submitting this form**

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