Order Request
**One Sheet for each Supplier
**Please identify how you plan to dispose of used chemical if applicable:
**Upon notification of arrival in the office you have 24 hours to remove the chemical from the office.
Quanity Name/description of item Price Total
To Order Catalog# include unit of measure (each, #/pack or #/case, etc) per unit cost
P.O. Number:
Order Written by:
Faculty authorizing:
A
ccount being used:
Chair's Approval:
Office Use
Placed Order:
Paid Via:
Date:
Other Comments:
Supplier:
E-Mail:
ne#Supplier's Pho
Fax #