UNIVERSITY OF MARYLAND at COLLEGE PARK



UNIVERSITY OF MARYLAND at COLLEGE PARK

REQUISITION FOR PURCHASE

|REQ NO. |FRS NO.-SUBCODE |FISCAL YR. |REFERENCE BID NO. OR CONTRACT NO. |

|      |      |      |      |

|Dept: |      |      |      |

|FEI # |      | | |

|VENDOR NAME |      |DELIVER TO: |University of Maryland / IREAP |

|VENDOR ADDRESS |      |ADDRESS |1203B Energy Research, Bldg. 223 |

| | | |8279 Paint Branch Drive |

|CITY / STATE / ZIP |      |CITY / STATE / ZIP |College Park, MD 20742-3511 |

|PHONE/CONTACT |      |PHONE / CONTACT |(301) 405-5039 Nancy Boone |

|SEND PO |DEPT. –CAMPUS |ADDRESS |ATTN: |DATE DESIRED |

|COPIES TO |IREAP / UMCP |1203B Bldg. 223 Paint Branch Drive |Nancy Boone |      |

|CITY |STATE |ZIP CODE |DEPT. CONTACT FOR BUSINESS MATTERS |PHONE |

|College Park |MD |20742-3511 |Nancy Boone |301-405-5039 |

|AUTHORIZED FUNDS ARE AVAILABLE. IN ACCORDANCE WITH FEDERAL OMB CIRCULAR |EMAIL | |

|A-110 , EQUIPMENT HAS BEEN SCREENED AND IS NOT AVAILABLE FOR OUR USE. |nboone@umd.edu | |

|PRINT DEPT. AUTHORIZER NAME |DEPT/SUB DEPT CODE |DEPT. CONTACT FOR TECHNICAL MATTERS |PHONE |

|Judi Cohn Gorski |IREAP |      |      |

| | |EMAIL |

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|DEPT. APPROVED SIGNATURE |APPROVED DATE | |

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|ITEM |DESCRIPTION OF ARTICLES OR SERVICES |QUANTITY |UNIT |UNIT PRICE |AMOUNT |SUB |

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|     |TOTAL |      |      |      |      |      |

IF ADDITIONAL SPACE IS NEEDED, OR TO CONVEY SPECIAL REQUESTS TO

THE BUYER, PLEASE STAPLE A SEPERATE SHEET TO THE REQUISITION

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THIS IS NOT AN ORDER.

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