Chemical Stores Order Form

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*