ORDER REQUEST

Ship to attn:
Ship to
address:
Phone #:
Fax #:

Ms. Fredda Wagner

Trenchless Technology Center
Louisiana Tech University
599 West Arizona, Ruston
LA, 71270.
318-257-4072
318-257-2777

Vendor name:

HobbyTron.com

Vendor
address:

24700 Avenue Rockefeller

Santa Clarita, CA 91355

Date Submitted: 9/23/2016

Acct to
NYSERDA
charge:
Contact
Dr. Erez Allouche
person:
Room : EA 203
Office
318-257-2852
phone#:
Location of
Trenchless Technology
Items
Center
This section for
Office
onlyRuston,
599
West use
Arizona,
Order by:

Reference:
Vendor phone
#:

(818) 675-9000

Vendor fax #:

(818) 675-9002

Date ordered:
Confirmation
#:
Date
completed:
Requisition #

Vendor contact
person:
Email address:
Part # for
listed vendor
Product ID # AZ12681

Description of Item(s)
RC Mini Lifter Forklift

APPROVED BY AD/CTR DIRECTOR: _______________

Qty
1

Cost each
unit

Total Cost

24.95

24.95

GRAND TOTAL

24.95

____________________ DATE: _____________ ______

APPROVED BY PI (if required):_________________________________________

DATE: __________ ________

FOR IFM ONLY: If purchasing chemicals, are the MSDS sheets attached? _________YES
OR is chemical on approved list? ________
APPROVED BY COES RESEARCH FACILITIES DIRECTOR ________________________________________________
PLEASE ATTACH PRICE DOCUMENTATION TO YOUR REQUEST. THIS MUST BE A FAXED
QUOTE FROM THE VENDOR OR AN INTERNET PRINTOUT.
Revised Feb 2006