Equipment Procurement Form
Purchaser Name
*
First Name
Last Name
Purchaser Title.
*
Email
*
example@example.com
Purchaser Department
*
Please Select
CMC - PD
CMC - ARD
CMC - CPRD
Give a concise description of the items or services to be acquired, including their nature, justification and purpose. Include details on scope of use and departments that will be primary users of the equipment.
*
Include information about equipment footprint, electrical requirements and intended place of installation in the lab (bench no. or area of the lab)
*
Please indicate the purchase type.
*
Rows
Expected
Not Expected
Laboratory Equipment
1
2
Services for installation, implementation, and integration
3
4
Various (e.g. furniture, hardware, general services, electrical support for the equipment install etc.)
5
6
Licensing of Software / Future software upgrade
7
8
Maintenance / Service Plan / Warranty
9
10
Hardware and software for computers
11
12
Finance support for payment contracts
13
14
Other
15
16
Please indicate support service required from IT, Purchasing and Facilities
*
Rows
Required
Not required
Inspection for readiness of electrical outlets (performed by facilities)
17
18
Ordering and installation of desktop/IT hardware/software
19
20
Inspection of dedicated space for equipment install (performed by facilities)
21
22
Unloading/receiving of equipment (performed by facilities)
23
24
Calibration / Maintenance contract
25
26
EHS inspection (for establishing protocols to ensure safe use)
27
28
Please attach the PO/Quote for the equipment. If applicable, include service contract and other included purchases
*
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Expected Date of Purchase
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Lead Time (weeks or months)
*
Expected Date of Arrival
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional comments
Additional comments
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