"FORM PO REQUEST"
Center for the Study of Health & Risk Behaviors UW Department of Psychiatry and Behavioral Sciences, Box 354944 PURCHASING USE ONLY PURCHASE ORDER REQUEST PO/ Procard ID#: Return Form to Fiscal Staff Date Entered: 1100 NE 45th St, Ste 300, Room 305 Obj-Code: Phone: 206-685-4931 Fax: 206-616-1705 TASK: OPT: PROJ: REQUESTOR INFORMATION Name: Phone: Email: Date requested: VENDOR INFORMATION Company: Address: Phone: Fax: Attn: SHIPPING ADDRESS SHIPPING METHOD Attn: Ground (3-7 days) Address: 2-3 business days 2nd day air Overnight (expensive) Note: Please provide Sole Source Letter if order is over $3000.00 Part No. Description Qty Unit Cost Total Cost - - - - - - - - - - - - - - - - - - - Invoice to: Fiscal Staff Sub Total: $- UW, Psychiatry & Behavioral Sciences Use Tax (9.5%): $- Box 354944, Seattle, WA 98195 Estimated Shipping: Fax: 206-616-1705 Grand Total: $- BUDGET INFORMATION Budget # Budget Name: % Charge/Amount: Requestor Signature: Print Name: Date: PI or Authorized Signature: Print Name: Date: Department/Fiscal Approval Signature: Print Name: Date: UNIVERSITY OF WASHINGTON Center for the Study of Health & Risk Behaviors Department of Psychiatry & Behaviroral Sciences OFFICE SUPPLIES JUSTIFICATION FORM Office supplies can only be purchased on federal budgets with an office supply justification form signed by the PI attached. Be federal law, office supplies are to be charged to indirect cost recovery monies, not federal grants, unless 2 conditions are met as follows: 1) be used for science: i.e. paperclips used in an experiment 2) benefit the grant exclusively DATE: I CERTIFY THAT THIS PURCHASE IS GOING TO BE USED FOR GRANT # GRANT NAME EXCLUSIVELY. THE BENEFIT TO THIS GRANT IS: Requestor's name: PI's Signature & Date: Compliance Verification: Attach this form to your PO request before ordering office supplies for projects