Purchase/Payment Request Form

Purchase/Payment Request Form

This form is for:

Payments to vendors or non-employee individuals
Requesting a purchase to be made on your behalf
Requesting issuance of a purchase order (PO)
Employee reimbursements
Internal payments (e.g. CSU Facilities, Lory Student Center, etc.)

This form is NOT for:

Travel expenses (see instructions for travel)
Stipend payments (email Stipend Request Form)

Request Details

Name*

First and Last

Requestor Email*

Requestor Phone*

Phone

Person authorizing this purchase:*

First and Last Name

Department*

Select

This is for a senior design project

Payment Request: For payments to vendors when a purchase has already been made (invoice is required).

Purchase Request: For purchases to be made on your behalf (no payment made yet).

Reimbursement Request: For reimbursing a purchase that was paid for personally (itemized receipt showing proof of payment is required).

CSU Vehicle Reservation (IO) Request: To request an internal order number used to reserve a CSU motor pool vehicle.

Request Type*

If you need to claim travel expenses, please do so here.

Select

Account Details

I need to charge multiple accounts

CSU Account Number*

Include the sub-account, if applicable.

Percentage of transaction to allocate to the above account:*

If your allocation is not percentage based, please submit a separate request for each account.

If you need to charge more than three accounts, please attach documentation detailing the allocation, write "see attached" in the account field above, and uncheck "I need to charge multiple accounts".

2nd Account*

Include the sub-account, if applicable.

Percentage of transaction to allocate to the above account:*

3rd Account

Include the sub-account, if applicable.

Percentage of transaction to allocate to the above account:

Provide justification for this allocation:*

In a few sentences, describe how this benefits CSU:*

NOTE: If this is being charged to a sponsored project (account beginning in 53), please also include how this aligns with the objectives outlined in the project statement of work and/or budget justification.

Purchase Details

Is this reimbursement request being made on behalf of someone else?*

Yes

Payee Name*

Select the price range:*

<$10,000

$10,000 - $49,999

$50,000 - $100,000

>$100,000

Name of Suggested Vendor*

Vendor Email

Vendor Phone

Phone

Does this purchase qualify as a sole source procurement, meaning only one supplier can meet the need and there’s no other options?*

Note: A requirement for a particular proprietary product or service does not automatically justify a sole source procurement if there is more than one potential bidder or offeror for that item. A preference for a brand name product also does not justify a sole source procurement.

Yes

Price reasonableness must be demonstrated, select how you would like to proceed:*

Option 1: Attach quotations from at least two (2) qualified sources. Acceptable proof includes quotes, emails, internet searches, or documentation on verbal quotes to support this option.

Option 2: Reference a previous order for similar goods or services.

Option 3: Only one known source exists or only one single supplier can fulfill the requirements.

Option 1

Option 2

Option 3

Request for Sole Source Form Required

Complete the Request for Sole Source form and attach it to this request prior to submission.

An example of a completed Request for Sole Source form is available here.

In a sentence or two, describe the purchase:*

Total Amount to Pay*

Provide the name of an alternate supplier:*

Provide the price quoted by the alternate supplier:*

Previous PO Number*

e.g., 901210

Previous PO Price*

Previous PO Issue Date*

Did this purchase involve food, beverages, events, recruiting, training, promotion, or development activities?*

Yes

Open this official function form in a new tab, fill, and attach the completed form at the bottom of this page.

Common reasons for having an official function include:

Extending contact to include normal mealtimes
Creating an atmosphere necessary to attain the goal
Encouraging event participation to attain the goal
Enhancing social interactions to build community
Rewarding outstanding performance
Providing a forum to raise awareness of an issue
Providing an opportunity to welcome visitors

(https://www.engr.colostate.edu/operations/ebo/wp-content/uploads/sites/2/EBO-OfficialFunctionForm.pdf)

How did you determine this is a fair and reasonable price?*

Supplier was the lowest bidder.

Other factors were considered.

Provide an explanation below to support your decision. Your decision must be based on best value criteria including scientific, technical and/or economic reasons. Attach additional documentation if necessary.*

Are you requesting purchase of a single item worth at least $5,000 or combined items that create a system worth at least $5,000?*

Yes

Open the Capital Equipment Supplement form in a new tab, fill, and attach the completed form at the bottom of this page.

Required when:

Purchasing a single item over $5,000 (federal)/$10,000 (non-federal) or;
Combined multiple items creating one system over $5,000 (federal)/$10,000 (non-federal) or;
Software with a total cost over $5,000 (federal)/$10,000 (non-federal) with a useful life of more than one year.

Delivery Information

Deliveries are handled by CSU's Central Receiving department which delivers to dedicated consolidated delivery locations throughout campus as defined by Campus Delivery Codes.

CSU Building Name or Number*

Room Number*

Conflict of Interest

A conflict of interest refers to a situation in which financial, professional or other personal considerations may directly or indirectly affect, or have the appearance of affecting, an employee's professional judgment in exercising any university duty or responsibility (see Academic Faculty and Administrative Professional Manual D.7.6 and D.7.7). State employees are additionally held to fiduciary and ethical standards described in C.R.S. § 24-18-103, C.R.S. § 24-18-104, C.R.S. § 24-18-105, C.R.S. § 24-18-201, and C.R.S. § 24-50-117.

Outside financial interests held by a CSU employee that relate to their professional responsibilities or relate to any CSU contract they may influence must be disclosed through the Outside Activities Report in Kuali. The Conflict of Interest Office will work with campus offices to advise strategies that reduce, manage, or eliminate the conflict.

“Immediate Family” includes employee’s spouse, domestic partner (as defined under the University’s benefits plan) or civil union partner (as defined in C.R.S. §14-15-103) and legal dependents (as determined by the Internal Revenue Service Code). “Spouse” means a person who is legally married to an Eligible Employee, including a common-law spouse or same-gender spouse when the applicable jurisdiction’s law recognizes such marriages.

I attest that, to the best of my knowledge, no CSU employee or their “Immediate Family” member is associated with this purchase, and has no actual or perceived conflict of interest affecting this request.*

Documentation is Required

For payment requests, attach an invoice showing the total amount due and remit details.

For purchase requests, please provide a formal quote when possible. If a formal quote is not viable, please attach a screenshot of what you need.

For reimbursement requests, attach itemized receipts showing the total amount paid with proof of payment.

File Upload*

Drag and drop files here or

Transportation Services Internal Order

CSU’s Transportation Services offers motor pool vehicles for rent. An overview of the program is available here. Drivers must have a recent Motor Vehicle Record (MVR) check on file before a vehicle reservation can be completed. To request a MVR, contact your home department.

CSU Vehicle Rental Rates

An electronic internal order (IO) number must accompany all reservations. Submit the form below to request an IO number. Once received, complete your reservation with Transportation Services here.

Is this reservation request being made on behalf of someone else?*

Yes

Driver's Name*

First and Last

Vehicle Type(s)*

Select

Vehicle Quantity*

Reservation Start*

Reservation End*

Destination*

City, State

Estimated Round Trip Mileage*

Is there anything you would like us to know about this request?

Send me a copy of my responses

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