College of Biological Science Purchasing & Financial Transaction Request Form
BIOBAR
DESCRIPTION
Date: ________________________________
Requestor
Name:
Ext.________
*Authorized Signature
Supplier: __________________________________________________ Phone: _________________
Address: __________________________________________________ Fax: ____________________
__________________________________________________ Quote # _________________
Orders of $3000 or more require
Dean / Chair Signature:
Authorized Signature
Dry Ice / Hazardous
Shipping and Handling
SUB TOTAL
HST
GRAND TOTAL
Date Ordered Ordered by
FUND
UNIT
GRANT / PROJECT OBJECT AMT %
Contact Paid with P.O. Visa
Conf/Ref #
Delivery
Courier FedEx Purolator DHL
SUBMIT
Ship To
Dept.:
___________________________________
Room: ___________________________________
Building: _________________________________
Attention: ________________________________
____________________
Lab Name: ________________ Ext. ___________
AUP/Permit # _________________
UNIT PRICE
AMOUNT
STATUS / INV#
Name: _______
QUANTITY
U of M
CAT #
Clerk
BIOHAZARD
RADIOACTIVE
Chair Signature: $5,000 to $25,000 inclusive
Dean Signature: $25,000 and above
CHAIR
DEAN
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
13.00%
This section to be used by CBS Purchasing Staff
0.00
CAD
Print
CBS
*I hereby authorize the CBS Clerical staff to place this order as presented, along with any unquoted incidentals
(e.g. freight, duty, taxes), pay the associated invoice (with the approved packing slip) and process all financial
transaction requests. If the base price varies within $100 of the quote, the order can be processed.
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