PIMD Office Supply Order Request Form

Requests are processed twice a month: on the 1st and on the 15th.

Requester Name*

First & Last Name

Requester Email*

Today's Date*

Vendor*

Item/Product Name*

Quantity*

Price*

Price per item

Item # (if applicable)

Model # (if applicable)

Notes/Additional Info

ex. indicate if from eBuy or Telework Catalog, website link, etc.

Tracking Desired*

Select

Shipping Address*

File Upload

File, image, or email, helpful when putting in the order

Drag and drop files here or

Send me a copy of my responses

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