Professional Services Contractual Agreement Request Form

Examples include: consulting, marketing analysis, banking services, medical services, physicians, software development/design, and auditing services. Professional services are defined as unique, technical and/or infrequent functions performed by an independent contractor qualified by education, experience, and/or technical ability to provide services. The services rendered are predominately intellectual in character, even though the contractor may not be required to be licensed. Professional services engagements may involve partnerships, corporations, or individuals.

Requesting Department Information

Department Contact Name

Department Contact Address

Department Contact Phone Number

Department Contact Email

Your Name (if different from contact name):

Worktag (Account Number):

You must enter a valid Program/Project/Gift/Grant Worktag

Department Detail (Optional):

Business Purpose:

This is the detailed purpose of the order explaining why the university is making this purchase.

Supplier Information

Supplier Name

This may be a company or an individual.

Supplier Contact Name

Supplier Email

Current or Former employee?

Yes, the supplier is a current or former employee of the University.

I don't know

Current or former student/postdoc?

Yes, the supplier is a current or former student/postdoc.

I don't know

If yes, will the contracted work be similar to work performed as an employee, student, or postdoc?

How or why was this supplier selected?

Have you worked with them in the past, do you know them, etc.

Contract Information

Please choose the type of contract needed:

You can either select from the dropdown menu or type in your answer.

One-time service or ongoing?

One-time

Ongoing

Start Date of work or agreement:

End Date of work or agreement:

Description of Services:

What will the supplier provide to you?

Example: reports, presentations, trainings, etc.

When is the supplier required to provide these deliverables?

(Provide dates or timeframes, ex: 3 weeks from start of project)

Provide the total dollar amount for this work (not including travel expenses):

It is preferred to pay based on receipt of the deliverables described above and not a per hour rate.

Will travel expenses be allowed on this contract?

Contractor is responsible for travel expenses. University will not pay or reimburse for travel expenses.

University will reimburse Contractor for University-approved travel expenses.

University will pay service providers directly for University-approved travel expenses.

University will reimburse Contractor for [describe expenses below] and pay service providers directly for [describe expenses below].

Contractor shall submit invoices for payment in accordance with the following schedule (select one):

One invoice upon acceptance of the Services and deliverables.

Periodic invoices submitted [monthly, quarterly] for portions of the Services completed at the time of the issuance of the invoice.

If you are working with a Procurement Agent on this already, please choose the name of the agent:

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