Order Request

Form
University of

Name & Address of Supplier

Brighton
S.E.T. / C.E.M
Efin supplier code:

(if known)
Date:

Order No:

_______________

_______________

Efin code
Purchase requested by: ...........................................................................................................
Purchase requested on behalf of: ............................................................................................
Purchase required for: ...............................................................................................................

Quantity

Cat. No:

Specification of Product

Each

Urgency: Very 1 day 2 days 1 week Date:

Sub-Total

Notes:

VAT
TOTAL

Total

To be completed by a Technical Manager

Date _____________

Purchase approved: Y / N

COSHH forms required: Y / N

In case of any missing specification, the Order Request Form has to be rejected and sent back.

Name: ...................................................

Signature: .