(FATC) Funds/Access Temporary Department Cards I certify that I have read and understand the information displayed above. * Sign Selecting this option will display the entire form below. Do not submit this form without completing the below fields. Department Information Department Name * Cost Center # * Business Purpose * Requester Information Name * Phone Number * Email Address of Requester * Date * Certify that I am the requester indicated above and that I approve this request. * Sign Department Head Information Name * Email Address of Department Head * Card Functionality & Design Quantity * What functionality are you requesting to be added to the cards? * Access – Swipe Access to Campus Building, Doors, Labs, Rooms Bear Bucks – Funded Temporary Cards Card Access AND Bear Bucks Funds Cards with multiple functionalities may take longer to program. Bear Bucks Funds Restriction Options * Unrestricted – All On-Campus Terminals On-Campus Food Only Sodexo Food Only On-Campus Dining Restricted – exclude Paws & Go, Bear Necessities, and Follett Bookstores On-Campus Dining Restricted – Food Only with $20 Transaction Limit & $50 Daily Limit Inquire for a detailed list of terminals in each category. Card Design & Provider * Standard Cards Provided by Purchasing Department (e.g. Knight Center) What would you like the card to say? 26 Character Limitation. Will be printed on Standard WashU approved logo/design. File Upload Drop a file here or click to upload Choose File Maximum file size: 104.86MB Department or event logos if you would like them included on the card. Funds Funds per Card * $.00 Access Describe Access, Buildings or Doors Listings * Card Access Requests are subject to review by Card Access & Electronic Security. For questions regarding access, email cardaccess@wustl.edu. Timeline Requested Card Pickup Date by Department * Expect 2 weeks to process this request. For expedited timelines, please email campuscard@wustl.edu. Card Activation * Card Deactivation * Holds will be placed on funds and card access will be disabled for all cards on this date. Activation time cannot exceed 2 years. Cost Summary Bear Bucks Card Processing Fees $1 processing fee per card. Access Card Processing Fees $10 processing fee per card Access/Bear Bucks Cards Processing Fees $11 processing fee per card Access Card Processing Fees, Provided Cards by Department $0.50 processing fee per card Aggregate Loaded Bear Bucks Quantity of Cards * Funds per Card Design Fee Card Design Fee, if applicable Total Bill to Department Submit Request If you are human, leave this field blank.