Please Fax Completed Form to 556-5650 or return by email
Online Order Entry Registration Form
I. To Be Completed by Person Who Orders Supplies:
Name ______________________________________Phone _________________
Department _________________________________ ML# _________________
Your orders will usually be delivered to:
Building __________________________________ Room # ________________
Email Address ________________________________________________________
Please provide your UC 6+2 for your login name ___________________________________
Your password will be your UC 6+2 which you should change upon your initial login to the system.
Please provide the account that will be used for the majority of your orders. Your orders will
default to this account, but you will be able to change the account number if necessary.
GL Acct __ __ __ __ __ __ Fund __ __ __ __ __ __ __ Cost Center __ __ __ __ __ __ __ __ __ __ Func Area__
II. Supervisor’s/Business Manager’s approval, if applicable
I understand each user account can be set up either 1) with authority to approve orders, OR 2) to require
purchase approval by a second authorized user. Please set up the account for the user indicated in Section I
so that:
____ No second approval is required OR ____ My approval is required.
If supervisor’s approval is required, I understand that it is my responsibility to notify Central
Stores if/when I or the user indicated above are no longer authorized to place orders.
Supervisor’s signature _________________________________________________
Name _____________________________________ Phone _________________
Email Address ________________________________________________________
Please provide your UC 6+2 for your login name ______________________________
Your password will be your UC 6+2 which you should change upon your initial login to the system.