Chemical Stores Order Form

We will be closed June 26 thru June 28 for our annual inventory. Except for liquid nitrogen or other critical needs, no transactions will be made during this time. Any non-critical orders will be held for processing until the following week. Please plan accordingly to make your purchases ahead of time and have all your items picked up by June 25. Please contact us if you have any questions or concerns.

Form Instructions

Please note: Any order containing any of the following items will require additional review. Please allow 2 business days to process the approval.

4kg (5 gallons) or greater of any individual chemical
1kg or greater of any acutely toxic chemicals listed on the EPA's table 205a

* Required Field

Vendor

If vendor is not listed above, enter name here

Order Notes

Requester Name*

Phone*

Requester Email*

Please enter a valid Michigan Tech email (@mtu.edu)

Secondary contact

Secondary Phone

Secondary contact email

Date Needed

Rush (next day, 2day, overnight) orders may incur increased shipping and packaging costs as determined by vendor.

RUSH ORDER

Catalog #	Qty	Size	Unit	Description	Unit Cost	Total Cost






			Estimated Total: $

Account*

Name of faculty advisor*

Department*

When your order arrives would you like*

Pickup

Delivery (Only available for chemicals or hazardous items)

Building/Room Number where the chemical and/or order will be used/delivered

Building

Room number*