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OFFICE OF Logistics Management

Central Warehouse and Distribution Services

SIGNATURE/ACCOUNT AUTHORIZATION AND MAINTENANCE FORM - MM-20
Central Warehouse On-Line Ordering System

Please fill in the following information for the employee who is authorized to sign for the 
Copy Center in your department/division(s).  This form is only for Copy Paper Orders.

Date:    
 
Department:

Division(s):        
           
                   

Mailing Address:          
        
Mail Code:     MC                  
                                                Bldg./Floor/Room #

AUTHORIZED EMPLOYEE:            

Telephone:        E-Mail Address: 

TITLE:     

NT USER NAME:  

EMPLOYEE SIGNATURE:     _____________________________________________     

DATE:                           Fax Number: 

AUTHORIZED BY:           

TITLE:   

Telephone:                  E-Mail Address: 

SIGNATURE:  ____________________________________________        

DATE:                           Fax Number: 

REQUEST:                 Add new user and following accounts     Add following accounts or update expiration dates
                                   Delete user and associated accounts      Delete following accounts

AUTHORIZED FOR ACCOUNTS:                

Ship-To No.                                           
                                    Ledger -  Account                                 Ship To Location

              3    -  27214                          

FOR OFFICE USE ONLY:

NT User Name: _____________________________ Date: ____/____/____

WEB Password: _____________________________        Signature (OPMM):      _____________________________________

Mail the completed form to The Office of Logistics Management, MC 6170 or FAX X-1993.