Charge Request
Original of this form is your authorization to charge

(Must be submitted to Payment Services before reserving travel)


  CR #: -
see instructions BUSINESS UNIT:   
  (insurance provided for employees; do not purchase additional insurance)
 Car Rental Agencies that accept this form.
 
"I am in possession of a valid California driver's license.  I certify that I have not been issued more than three moving violations or have been responsible for more than three accidents (or any combination of more than three thereof) during the last twelve-month period."
_________________________________  _____________________
Signature of Applicant                      Date
  (Quote/receipt with price must be attached)
  
  Hotels that accept this form
 
 
 
 
 
 
__________________________________
Signature of Applicant / Requestor





__________________________________
Dept. Head Signature 
 
* Quote must be attached
 
 

 
SEND INVOICE TO:
California State University, Bakersfield
ADM 35 - Payment Services
9001 Stockdale Highway
Bakersfield, CA 93311-1022

Accounting Approval


Date

Original to be retained in Payment Services for processing.

 
NOTE: Make sure values on form are correct as
VALUES ARE CLEARED BEFORE PRINTING AND FORM IS REFRESHED!

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