Purchase_Request by xuyuzhu

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									                                                                                                                     OFFICE USE ONLY
                                                                                                                     __/__/__ Date Received pM p W
                                                                                                                     ________ Time Received
                                                                                                                     ________ Received By

                                                                                                                     p All info attached (checklist below)
                                            2110 Hillside Road Unit 3008
                                                                                                                     PAY BY DATE: __/__/__
                                               Storrs, CT 06269-3008
                                                   (860)486-6515
                                            uconnclubsports@uconn.edu                                                $_______ Current balance
                                                                                                                     $_______ Balance after purchase


         Club Sports Council Purchase Request Form
This form will only be processed if the following information is attached, the form is typed and if there is enough funding in the club's allocated funding.
This form should be submitted at least 2-3 weeks BEFORE the pay by date and can only be submitted on Mondays or Wednesdays.
o List of team members & peoplesoft #s participating
o Website/Flier/Invoice with payee name and address
o   Website/Flier/Invoice with HOW to PAY : p       Check   p Credit Card
o   Pay by date : __/__/__      p Mail p Pick up @ Club Sports Office
o   Travel itinerary submitted via UCONNTACT (If applicable)
o   Other Instructions(Will you need a 'Promise to Pay', Login/Password info, Team already registered?):


     If applying for reimbursement (ENTRY FEES, LEAGUE DUES or FACILITY TIME ONLY) @ 50% COST
o Proof of payment; Copy of bank statement or cashed check
o Reason for reimbursement :
         **Teams will be responsible for all late fees for PRs that are submitted within 15 business days of the PAY BY DATE.

Club Making Request:
President's Name:
President's Email:
President's Phone Number:                                                                             Date of Event:
Date Prepared:


Vendor/Person:                                                                                        Federal ID or SS#:
Vendor/Person Phone Number:                                                                           Vendor Email:
Payment Address:



Name and Location of Event:
Reason for Purchase:

Item #        Item Description                                                                                         Qty.     Cost Ea                  TOTAL

1                                                                                                                                                             $0.00

2                                                                                                                                                             $0.00
                                                                                                                                                              $0.00
                                                                                                                                                              $0.00
                                                                                                                                                              $0.00

                                                                                                                                                              $0.00


                                                                                                                  Total Cost of Items                        $0.00

              Kori Smith
                     Print Name, Club Sports Council President                                        Signature of Club Sports Council President             Date
              Eric Dunn
                      Print Name, Club Sport Council Treasurer                                        Signature of Club Sport Council Treasurer              Date


                     Print Name, Recipient Club's Representative                                      Signature of Recipient Club's Representative           Date

                                                                                                                                          11/17/2012
Complete all fields unless indicated for use of Club Sports Council use only.


IMPORTANT

THIS FORM MUST BE TYPED. HAND WRITTEN REQUESTS WILL NOT BE PROCESSED

								
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