Charge Request Form

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:

BKCMP

BKASI

BKFDN

BKSTU

BKSPA

Car Rental (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

UNIGLOBE Air Travel (Quote/receipt with price must be attached)

Local Hotel (for Guests) Hotels that accept this form

VENDOR (Uniglobe, Enterprise, etc.):

TRAVELER:

VENDOR CONTACT:

DEPT CONTACT:

ADDRESS:

DEPT:

CITY:

CONTACT EXTENSION:

STATE & ZIP:

__________________________________
Signature of Applicant / Requestor

Dept. Head (Print Name-REQUIRED)

__________________________________
Dept. Head Signature

QUOTED COST(including tax):

* Quote must be attached

LOCATION &
DATES OF
EVENT/TRAVEL:

PURPOSE OF
EVENT/TRAVEL:

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

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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