Department of Chemistry Finance and Payroll Services Office

Requestee Information

Requested by:	, (last name)	(first name)	(middle)
Phone:
Email:
Ship To:
Attention:
Room #:

Vendor Information

Vendor Name:
Contact Person:
Address:
Vendor ID: (10) (if known)

Item Information

Quantity	Unit	Description (give part numbers and other details)	Cost/Unit	Total Cost
	Shipping and Handling		$
***The University of MN is a tax exempt organization and all purchases should be made with this in mind.***
Estimate Total Cost:   $

Account Information
(NOTE: Not all accounts use all chartfields)

Name of research project or title of Grant:

Chart String:
Fund: (4)
Dept ID: (5)
Program: (non-sponsored, 5)
-OR-
Project: (sponsored, 8)
Fin EmplID (8)
Chart Field 1: (10)
Chart Field 2: (10)

Justification

Who (name of individuals or the group to use the item(s)):

What (is being ordered; ie chemicals, equipment, software, etc):

Where (will this item(s) be used; ie lab room#, stockroom, etc):

Why (are you making this purchase) -OR- Why (is this purchase necessary for your research):

How (does this purchase benefit the account being charged) -OR- How (will this benefit the project when using sponsored funds)

Comments/Special Instructions:

Name of Account Owner (if different from Requester):

This request will be submitted to the Finance and Payroll Services office in 141 Smith Hall for processing.