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COMPONENT PURCHASES RESULTING IN EQUIPMENT IN EXCESS OF $1,000

Use this form when equipment is created, manufactured, built, and/or assembled from parts accumulated through various purchase orders and/or procurement card purchases. This form should be submitted as soon as equipment is assembled. The total value of the equipment after assembly must be at least $1,000. This form is sent directly to Inventory Control. Inventory Control will instruct an inventory clerk to tag the equipment and add it to the department inventory. A copy of the form will be returned to the department after tagging with a barcode number.

Department: (owner of equipment)

Custodian Department:

PeopleSoft Dept ID:

Default SpeedType:

Contact Person:

Email Address:

Phone:

Building/Room Number:

Description of Equipment: (35 spaces allocated on inventory data program.  If computer related then first word must be computer.)

Primary Purchase Order Number:

Secondary Purchase Order Number(s):





ProCard Purchases:

Date:     Amount:     Description:
Date:     Amount:     Description:
Date:     Amount:     Description:
Date:     Amount:     Description:
Date:     Amount:     Description:

Total Value:

Acquisition Date:

Serial Number:

Model Number:


Form Prepared By:      Email Address:

Approved By:      Email Address: