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Vendor Name: Address: City, State, Zip

Summary: Date:
Vendor Name:
Address: City, State, Zip:
Phone #: Contact/Salesperson:
Quote? (y/n): (please attach)
Orderedby: Ext:
Date needed:
Where will this equipment be located: Building #: Room #:
Please answer the following questions that may apply to this purchase.
1. Is purchase an add-on to existing equipment?
If yes, what is the UC tag# of the existing equipment?
2. Is this purchase a new fabrication or part of one?
If yes, what is the name of the fabrication?
3. Please check below if your purchase falls into any of the following categories:
P.I.'s to fill out this section:
Professor's signature/approval:
Account/s to be charged:
Is this purchase in:
1. The account's budget/proposal? (y/n):
If yes, under equipment or supplies?:


Source: Akhmedov, Azer - Department of Mathematics, University of California at Santa Barbara


Collections: Mathematics