Professional Services Contractual Agreement Request Form

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.

No

I don't know

Current or former student/postdoc?*

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

No

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.

Select or enter value

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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