GENERAL ORDER REQUEST FORM

This form must be filled out completely before an order will be issued. Faculty advisor approval is required.

DATE:
FUND:
Document #:
Activity/Project #:
SUBCODE: Check One
62600 - Lab Supplies
61100 - Fabricated Equipment
65300 - Maintenance/Repairs
61400 - Insurable Equip (> $5,000)
Other:
Deliver To:
Student Name
Faculty Member
Faculty Signature  
Vendor:
Vendor Name:
Street Address:
City, State, Zip:
Phone/Fax:
Sales Rep:
University of Utah
Department of Chemical Engieering
50S Central Campus Dr. Rm 3290
Salt Lake City, UT 84112
Bill To:
University of Utah
Accounts Payable
201 S. Presidents Circle Rm 405 Salt Lake City, Utah 84112-90
Merchandise / Service Information:
Quantity/UnitDescription of Merchandise/ServicePrice/UnitTotal
Total Cost of Purchase
(must not exceed $3,000.00)