Chemical and Biological Engineering Purchasing Card Worksheet

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CHEMICAL AND BIOLOGICAL ENGINEERING

PURCHASING CARD WORKSHEET


Please fill out this form completely, get approval signature(s), place your order and give to Christi in 2114 Sweeney Hall along with any
receipt(s) and packing slip(s). Completed paperwork is a must for auditing purposes.

REMEMBER that all purchases must be Tax Exempt and that an itemized receipt is needed!
Date Ordered: 6/14/16
Vendor Name: Newport Corporation
Vendor Address: 1791 Deere Avenue, Irvine
CA 92606

Card Holder: Russell Mahmood


Approved By:
(Acct Owner's Initials and Jody's Signature)

Account No.
420-62-23

(Check one:)

Telephone No.: (800) 222 6440


Spoke To:
Confirmation #:

Phone Order:
FAX Order:
Web Order: X

Catalog Number & Description of Item(s)


KPC034 Lens, BK7, PCC 1.00 Inch Dia

Qty
1

Unit Cost
33.00

TOTAL

Amount
$35.31

Est. Cost
33.00
$
33.00

Reason for purchase - be specific. What is the item to be used for? (Example: Lab supplies: optical component for SPR imager)
The lens was made into a optical mirror and used in laser interference lithography, in Prof. Hillier's Lab.

Location where items will be kept:

Lab 3117

Ship to address: CBE Department, 2114 Sweeney Hall, Iowa State University, Ames, IA 50011-2230
Department Phone: 515 294-7642 ~ Department Fax: 515 294-2689
The following information is only needed when using your P-Card for hospitality purchases.
Business
Purpose

Begin Date

Participants - (List all those that attended the event)


Location
Event Type
Departmental Use Only
Tran/Ref #

Class Code

Hazardous Materials Surcharge

Validator

App. By JGD

Copy Made for Account Owner

End Date

Not a CBE Administered Acct:

(Revised ~ 11/09)

with any

er)

d ~ 11/09)

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