How to Complete Purchase Request Form 100

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1. Vendor Name - Fill in, if available, the suggested vendor(s) name, mail to address including city, state, zip code, voice and fax telephone numbers. It is not necessary to complete this section, in which event, Purchasing and Payment Services will select a best vendor from sources registered with the University. If the total dollar value of the Purchase Request CPS Form 100 is $5,000 or greater, a suggested vendor may be filled in for this section, but other known acceptable suppliers should be offered as an attachment to the Purchase Request form. Such action will assist Purchasing and Payment Services in selecting sources for competition.

2. Required Delivery Date - State your required delivery date for the product or service requested.

3. Requested By - Fill in the requester's name, campus mailing address, campus telephone number and the date you are filling out this request.

4. Department Code Number - Enter your 4 digit department code and 2 digit delivery code. Delivery code number will become the "ship to" location designated on the Purchase Order document to be sent to the vendor. If the ship to is different from the delivery code number, as currently recorded in the FAS accounting system's computer file, please fill in the "SHIP TO" section.

5. Authorized Individual - Fill in the authorized individual's name, campus telephone number, date this request is signed, signature of the authorized individual and 6 digit payroll number.

6. Ship To Information - If the ship to information is different from the department code or delivery code, complete the ship to space including the ATTN.: line. If you leave the ATTN.: line blank, the REQUESTED BY will be used.

7. Inside Delivery Requirement - Indicate with an X in the YES or NO box if inside delivery is required.
8. Account Codes - If the total order is to be charged to a single account or split among various accounts, use boxes 1, 2, 3 and 4, as necessary. The percentage must equal 100% and be in whole numbers. If all items are to be ordered from the same company and if each item is to be charged under a different account code, use bottom portion of form under the column ACCOUNT CODES.

9a. Item No. - Enter, in sequence, the number of each item being ordered.
9b. Quantity - Enter the amount you wish to order.
9c. Units - Enter the unit of measure, i.e. ea., box, doz.
9d. Catalog No. - Enter the vendor or manufacturer's product or catalog number.
9e. Description - Enter the description of the product or service you are requesting, be informative and complete as possible.
9f. Net Unit Price - Fill in, if available, the net unit price

10. Equipment Screening - This section should be completed only if any of the funding as indicated in the ACCOUNT CODE section is provided as Ledger 5 and the sub-account is in the 6XXX series (except 6400 manufactured equipment parts). Be sure the equipment coordinator for the submitting department or the equipment coordinator for the LBC signs the EQUIPMENT SCREENING STATEMENT if an account code is a LEDGER 5 and you would like to purchase equipment at $5,000 or more per item.

The screening statement must be completed when requesting the purchase of an item of equipment that costs in excess of $5,000 charged to a federal award. The equipment coordinator's signature and date of signature are required.

11. Assigned Purchase Order No. - If you requested an emergency purchase order in advance of submitting the form 100, enter the assigned purchase order number in this space.

12. Backside Instructions