Request For Acquisition Of Goods And Services Form
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1REQUEST FOR ACQUISITION OF GOODS OR SERVICES
BRC
Business Resource Center
USE SEPARATE FORM FOR EACH VENDOR/PAYEE
Dept. Code
PO:
Vendor / Payee:
Check if portion will be recharged
and attach BRC Recharge Form
(SHADED AREAS FOR BRC USE ONLY)
UC Employee Yes No
_________
Originating Department _____________________________________________ Date _________________________
Requestor: ____________________________________________________
EXT:
Person(s) to be copied on the BruinBuy order:
Name
UCOP Email
Phone
Name
UCOP Email
Phone
Business Justification of this expense:
Account
Fund
Project Sub Object Source %
M‐
-
-
M‐
-
-
(Attach separate sheet if additional FAU is needed)
CHECK ONE CATEGORY ONLY.
Request for Vendor Payment
(e.g. FedEx, Arrowhead, Verizon, publications & subscriptions, etc.)
Description of Services:
Conference & Events ‐ Vendor Payment Request Only
(includes Business Entertainment)
Required Attachments
Host Name
Date
(Printed): ___________________________________________________________
____________________________________
Alcohol Served
Purchase of alcohol may not be
Attendee List
permissible under certain funds.
Host Signature:
_______________________________________________________________
Agenda
Original Invoices
Description:
Recharge form when
applicable
Supply/Equipment Orders
(Attach separate sheet if additional space is needed)
Complete Description of Items (color, size, etc.)
Ship to Address:
Unless otherwise noted
Qty/UOM
Catalog #
Pg#
Price
below shipment will go directly to requestor.
You may attach your department supply order form and reference ‘see attached’ below.
1.
2.
3.
4.
5.
Approving Authority Statement: I approve this commitment of department funds for the stated University purpose
I certify that it is an appropriate use for
.
the fund source and that the transaction complies with University policy.
________
TOTAL $
Approving Authority Signature:
_________________________________________________
Print Name: ______________________________________
Date__________________
LINK:
Acquisition of Goods or Services Instruction Sheet
BRC 11/10
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Parent category: Business