Fillable Purchase Order Form printable pdf download

Purchase Order Form

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Order No. _____________

PURCHASE ORDER FORM

This form and all required documentation must be filled out and returned to the MIE Business Office to complete

order.

Date Submitted:

Name/UIN Number:

PI or CoPI Name and Signature: You may attach e‐mail if signature is not provided.

_________________

Account Number to Charge:

_________________________

Company Name /Phone:

_________________________

Please confirm if items ordered are consumable (within year, example saw blades, chemicals, masks)

If item is permanently incorporated into another item. Please supply UIC inventory number.

Please indicate if item is over 500lbs and needs room delivery. Vendor MUST have delivery options.

Department does not have special equipment to unload a truck. NO TAILGATE DELIVERIES

Inventory #

Catalog Number

Item Name/Description

Quantity

Unit Price

Amount

_____________________________________________________________________________________

Justification (See example):

Justification should be explanation of purpose (example: Item(s) for research related use on project…; Item for

business related use, etc.)

Purchase Order Form

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