Centralized Chemical Purchasing Chemical Requisition Form


Note: This form has been redesigned to accommodate multiple chemical requests. After you indicate how many chemicals you want, the page will dynamically adjust the space for you to put in your order information. Please also note, this form works best in

Internet Explorer .
1. Give your information  ( * = Required Field)

Your Name:  

Phone: *     Email: *
 Department: * Office: * Building: *
Principal Investigator (P.I..): *      Billing Contact:  *
Delivery Location (Building/Room No.): *
2. How many items do you want?       
No. Chemical Name Vendor CAS# Catalog # Quantity Size Estimated Cost
Surplus  If this chemical is available free of charge from the Chemical Surplus Program would you like to be informed ?
Alternate   If an alternate brand of chemical is less expensive or available more quickly would you like to be informed?
Shipping Preference   Air shipments arrive in 2 to 3 days; Ground shipments take approximately 1 week
Notification of cost   Do you wish to be notified via e-mail of actual chemical and shipping costs ?
Comments or special information

3. Submit the Order