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Work Requisition Form

Please complete the following form in order to request the services of the Department of Chemistry Electronic Shop. Required fields are in bold and blue.  

Note: All on-campus users - including Chemistry - must supply coding to process work orders. Also, the authorization form that will be mailed to you must be signed and returned before work can begin.

Note: Accounting codes are NOT required for Off Campus but you must fill in your contact info below

 Requestor Information
Requestor First Name           
Requestor Last Name           
Requestor Department 
Requestor Phone Number           
Requestor E-Mail Address       
 Account Holder Information (e.g. Supervisor)
  This information is required unless you specified Off Campus under Requestor Department.  
Account Holder Last Name           
Account Holder Department   
26 Digit Accounting Code 
Fund Unit Grant Project Object
 Off Campus Contact Info
  If you selected Off Campus under Requestor Department, you must fill out the following contact information.  
Postal Code   
 Job Description
Short Repair Subject 
(e.g. Broken IR Spectrometer) 
Preferred Technician   
Repair Description 
More detailed description 
of what is wrong. 
Service Location 
Service Location selection

(e.g. Building and Room)

I will bring the equipment to the electronic shop (MACN 062).
     Please arrange a drop off time in advance.

The equipment has already been delivered to the electronic shop.

Non-equipment service requests (e.g. Software).

  Pressing 'Verify Request' will verify that the form is complete and will present you with a summary. If you are satisfied you will be able to submit the request.