University of Vermont


dept card req

Departmental Debit Card DEPOSIT form

Department Name:

Department Chart String:

PS Account

Operating Unit


Dept ID

















*Note: For FAHC the Cost Center Number should be used. _______________________________________

Phone Number:

Number on Card

Value to be added











I am authorized to incur charges against this budget. I understand that this budget number will be responsible for all charges made to this card even if the card is lost, misplaced or misused, until a request to terminate the card is made to a staff member at the CATcard Service Center.
*Please note: a $5.00 charge for each card issued will be billed to the above budget number.

Name: (please print)

Signature:                                          Date:

For CATcard Office Use

Completed by:                                   Date:

Last modified July 17 2006 09:35 AM