Purchasing Request Form Request InformationDate* Name* First Last Department or Location*SelectArt and Art History DepartmentBallard Institute and Museum of PuppetryBenton Museum of ArtConnecticut Repertory TheaterContemporary Art GalleriesDean's OfficeDigital Media and DesignDramatic ArtsJorgensen Center for Performing ArtsMusic Departmentvon der Mehden Recital HallGood or Services to be Purchased*Please select all goods or services for purchase. Dues Fees (Professional, Conference Registration) IT accessories (peripherals, printer supplies) Rentals (Car services, Buses, Tables/Chairs) Professional Services (Adjudicators, Guess Artist, Designer, Consultant, Composer, Performer, Machinery Repairs, Catering, Advertising) Subscriptions Supplies (Educational, Promotional, Books, Lab, Office) Other Services (Repairs, Catering, Advertising, Laundry, Printing) Other Other Goods and ServicesIf you selected "Other" above, please specify the good or service. Otherwise, please leave this field blank.Purpose of RequestVendor Name*Name of Contact at Vendor* First Last Vendor's Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Vendor's Phone NumberVendor's Email* Brief Request Description*Please provide a short description for your request (5-6 words maximum).Full Item Description*Please be as detailed as possible.If you have attachments to show, please add here Drop files here or Link to Website*Date of Purchase Needed*Please allow at least one week lead time to process purchases. Some purchases may take longer than a week due to vendor setup and stipulations. Amount of Purchase Request*Actual or estimate value accepted. Is this an individual purchase request or one of many requests associated with a project?*An individual purchasePart of a projectName or description of project*Does this purchase require Facilities work?** Visit updc.uconn.edu and review terms for projects. * Yes No What is the nature of the Facilities work involved?New installation or change?