Procurement Request :Department of Chemistry

Procurement Request

STOP

Please check the Chemstores catalog before placing your order.

This form will be emailed to the Chemistry Requisitioning Office upon submission. Inquiries regarding order modifications or placement should be directed to chemreq@indiana.edu.

Requestor Information

Required by

Name

Phone Number

Email CC

Add Another

Affiliation

Account(s)

Add More

Identify account distribution here, if applicable.

Activity/Project Number

Supervisor Approval

Vendor Information

Name

Address

City

State

Zip

Phone

Fax

Contact

*One preferred vendor per request, please

Purpose

Will items be used to construct equipment?

Yes No

Fabrication Number

Will items be used to replace, repair, or upgrade existing equipment?

Yes No

IU Tag Number

Order Details

Shipping Instructions

UPS Ground 2nd Day Air Overnight

Overnight shipping will incur an additional expense, likely $30-$60.

Shipping charge variations depend upon shipping point and method.

Quantity	Catalogue or Item Number	Description/Specs	Unit Price	Unit Total Price

			ORDER TOTAL

Add Item

Comments/Instructions

Attachments

Hold Ctrl (Windows) or Cmd (Mac) to select multiple files.

Submit Order

If there are any problems with this form, please contact ITG.

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