Web requisition purchasing form (312)

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When to use this form

This form should only be used for the following:

Internal purchases (e.g. UR Tech Store, Barnes and Noble, Food & Nutrition)
University of Rochester Purchases (Clinical Supplies, Lease orders only)
Highland Hospital (all purchases)

Effective immediately, Corporate Purchasing will be enforcing the University of Rochester’s Bid Policy and Supplier Diversity Policy. These policies apply to Purchases $250,000 and above, and require departments to submit 3 bids and inclusion of at least one diverse supplier in the bid process. If you need assistance in complying with these policies, please email the Procurement Service Center.

Web Requisition

Step 1 of 3

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Unique ID

Is this vendor in Allscripts?(Required)

Yes

No

Internal Requisition

STOP!

Please copy and paste the link for the Vendor Add Form into your browser to submit a request to qualify a new supplier. https://www.rochester.edu/adminfinance/urprocurement/vendor-add-request-form/

Department Information

Shipping Location(Required)

Ship-to Department Street Address City State ZIP Code

Phone(Required)

Fax

Requester/Attention(Required)

First M.I. Last

Supplier Information

Suggested Supplier(Required)

If this is an Internal Requisition, please list the Department you are ordering from here. PLEASE NOTE: Internal Requisitions cannot be processed by Purchasing and should be sent to the Department listed in this field.

Supplier Code

Supplier Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supplier Phone(Required)

Supplier Fax

Supplier: Attention

First Last

Approvals Information

Requestor Name(Required)

First M.I. Last

Requestor Title(Required)

Date(Required)

Department(Required)

Intramural Address(Required)

Street Address Room/Suite/Box Number City State ZIP Code

Requestor Email(Required)

Requestor Phone(Required)

Dept/PI Approval Name 1(Required)

First M.I. Last

Signature(Required)

Title(Required)

Date(Required)

Dept/PI Approval Name 2

Sign next to name on printed form if this field is filled out.

First M.I. Last

Signature(Required)

Title

Date

Dept/PI Approval Name 3(Required)

Sign next to name on printed form.

First M.I. Last

Signature(Required)

Title(Required)

Date(Required)

Senior Admin Approval Name:

Sign next to name on printed form if this field is filled out.

First M.I. Last

Signature(Required)

Title

Date

Charge Account (Name)(Required)

Company(Required)

FAO + SC(Required)

UR Financial Activity Object + Spend Category

Percent Charged(Required)

Charge Account (Name)

Company

FAO + SC

UR Financial Activity Object + Spend Category

Percent Charged

Charge Account (Name)

Company

FAO + SC

UR Financial Activity Object + Spend Category

Percent Charged

Additional Notes?

This field is not required to submit your requisition. If there is any additional information you need to provide about this order, please include it here.

Accounts Payable Office

We are responsible for invoice processing and the disbursement of funds for payments of goods and services, employee travel and business expense reimbursements, awards, honorariums, stipends, and other non-payroll payments to faculty and staff in accordance with university policies and procedures.

Procurement Department

Leadership, management, and customer service for purchasing goods and services at all University and Rochester academic and medical locations including sourcing, supplier guidance, vendor management, sustainability, and contracts

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When to use this form

Web Requisition

STOP!

Department Information

Supplier Information

Order Information

Certification Statement

Item #1

Item #2

Item #3

Item #4

Item #5

Item #6

Item #7

Item #8

Item #9

Item #10

Approvals Information

Related offices and departments

Accounts Payable Office

Procurement Department