Bookstore Interdepartmental Authorization Form
Department_____________________________________________________________
Account Name (How you would like it listed in the system)________________________
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Account #______________________________________________________________
Authorized Names on Account
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Contact Person for Account_______________________________________________
Email Address________________________Phone Number______________________
Department Head________________________________________________________
Signature_____________________________Date______________________________
Mail or Fax this form to Laurie Davis or Velma Bails at NGCSU Campus Connection.
FAX: 706-864-1466.