HAS Purchase Order Request

Date Requested

Requestor Information

Requestor Name (Last, First)

Requestor Email

Requestor Phone Number

Phone

Purchase Details

Vendor Name

Vendor Contact Name

Vendor Contact Email

Sole Source Justification

Purchases over $25,000 require either a sole-source justification or two additional quotes. You will attach a sole-source memo or the additional quotes below.

Yes

Business Purpose

Please explain how this purchase benefits the account you are charging.

https://financialservices.arizona.edu/accounting/business-purpose

KFS Account Number

Sub Account Number (if applicable)

Purchase Total

Tax Exemption

Do you certify that this single item purchase over $5K is tax exempt?

This purchase will be used for research and development purposes as that term is defined by ARS 42‐5061(B)(15) and ARS 42-5159(B)(15). The exemption from sales tax pursuant to ARS 42‐5061(B)(15)

Yes

Capital Asset Information

Capital Equipment

Single item cost of $5,000 or more.

https://policy.fso.arizona.edu/pmm/200/210

Yes

Is Capital Equipment Budgeted

If you are using a federal research grant, capital equipment should be included in your budget. If not, you will need permission to proceed.

Yes

N/A

Building Location

If this is a capital equipment purchase, please provide the building name in which this equipment will be located.

Room Number

File Upload

Please upload the vendors quote (must have a non-expired date) a sole-source justification memo (if applicable) and the two additional quotes (only if you are unable to provide a sole-source memo for a purchasing exceeding $25K)

Drop your files here

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