Purchase Requisition Form
This form is to request a purchase order or check requisition for the following internal awards: Faculty Endowment Research Award (FERA); Undergraduate Research Award (Student Award); Graduate Research Award (Student Award); and 1881 Commemorative Award for Faculty Development.
Contact Information
Are you the award holder?
*
I am the award holder
I am placing on behalf of the award holder
Requester:
*
Prefix
First Name
Last Name
Requester Email:
*
example@example.com
Requester Cell Phone:
*
Award Holder Name:
*
Prefix
First Name
Last Name
Department
*
Award Holder Email
*
example@example.com
Award Holder Cell Phone:
*
This purchase is for Award:
*
FERA - Faculty Endowment Research Award
1881 Commemorative Award for Faculty Development
UGRA - Undergraduate Research Award
GRA - Graduate Research Award
Name of Faculty Mentor
*
First Name
Last Name
School of Faculty Member
*
Please Select
ADM Administration
ATH Sports and Athletics
CHASS Humanities Arts Social Sci
DSE Dreeben Education
FSP Feik Pharmacy
HEB Business Administration
MSE Math Science Engineering
NHP Nursing and Health Professions
RSO Rosenberg Optometry
SMD Media and Design
SOM Osteopathic Medicine
SPS Professional Studies
SPT Physical Therapy
NA Not Listed
Requested Purchases
Attach the official quote/s from the vendor below. Quotes must be dated within 30 days and not include sales tax. Please provide item name, item number, item description, quantity, shipping/handling fees, and the total cost. For Amazon orders, attach direct links and/or screen shots of the item/s.
I am requesting a:
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Purchase Order
Check Requisition/Reimbursement
Other
PIDM or Student ID
*
Required for Check Requisitions
Vendor Name/Payable To
*
Purchase Cost
*
Tax-free amount of purchase
Shipping Cost
*
Enter $0 if not applicable
Purchase Total
Auto-Calculated
Attach official tax-free quotes or receipts
*
Upload a File
Drag and drop files here
Choose a file
UIW does not pay/reimburse sales tax.
Cancel
of
Please confirm the availability of your item(s):
*
My items should be in stock and ready to ship
It is okay if my items do not ship immediately
Not applicable (service or online software)
The items I am requesting can be categorized as:
*
Computing Equipment-6581
Laboratory Supplies-6565
Textbooks/Books-6584
Other
Purchase Order Routing
Once a Purchase Order (PO) is received, please indicate how you would like it to be routed to the vendor:
Who will be submitting PO to vendor?
*
I will send the PO to the vendor
I would like ORGS to place order on my behalf
Notes/Instructions for ORGS (optional):
Please let us know if you have any further information to share for this order.
Campus Delivery Instructions
Please provide instructions for our shipping department:
Location
*
Select One
Broadway Campus
Non-Broadway Campus
Not applicable (service or online software)
Professional School:
*
Select One
RSO Optometry
SOM Osteopathic Medicine
FSP Pharmacy
PT Physical Therapy
NA Not listed (Please note below)
For locations not on the Broadway campus
School of:
*
Select One
CHASS Humanities Arts Social Sci
DSE Dreeben Education
HEBSBA Business Administration
MSE Math Science Engineering
NHP Nursing and Health Professions
SMD Media and Design
NA Not Listed (Please note below)
Building:
*
Select One
Administration
AT&T Center
Benson Fieldhouse
Bonilla Science Hall
Convocation Center
Founders Hall
Kelso Art Center
Music Hall CHASS
Nursing NHP
Gorman Center
Library
Modulars (Baseball Field)
Student Engagement Center SEC
NA Not listed (Please note below)
Room/Office Number:
*
Courtesy Email - Would you like to alert anyone via email of this order/delivery?
Ex., Lab Technician, Research Assistant, Admin Assistant, etc.
Notes/Instructions for UIW Shipping Dept? (We will include on PO)
If you are ordering chemicals or something that needs to be refrigerated, please indicate it here.
Authorization to Submit Purchase Request
By signing and submitting this form you are providing authorization for ORGS to submit the PO or Check Requisition request to the necessary departments for approval on your behalf. Please allow up to two weeks for processing.
Signature
*
Submit
Should be Empty: