Charge Request Form

Charge Request
Original of this form is your authorization to charge

CR #:

see instructions

BUSINESS UNIT:

BKCMP

BKASI

BKFDN

BKSTU

BKFFR

Car Rental (additional insurance at time of rental will be employee's responsibility)
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

UNIGLOBE Air Travel (BTA-Bus. Travel Account) (justification required for first-class service)

Group/Guest Hotel Hotels that accept this form

AGENCY/VENDOR:

NAME:

VENDOR CONTACT NAME:

CSUB ID#:

ADDRESS:

DEPT:

CITY:

PHONE:

STATE & ZIP:

__________________________________
Signature of Applicant / Requestor

Dept. Head (Print Name)

__________________________________
Dept. Head Signature

ESTIMATED EXPENSE:

LOCATION &
DATES OF
EVENT/TRAVEL:

PURPOSE OF
EVENT/TRAVEL:

Account:	Fund:	Department:	Program:	Project:	Class:

SEND INVOICE TO:	________________
California State University, Bakersfield	Accounting Approval
ADM 35 - Attention Karen
9001 Stockdale Highway	________________
Bakersfield, CA 93311-1099	Date

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