MATERIALS MANAGEMENT
OFFICE SUPPLY REQUEST FORM
REQUEST #:  Hit Counter
REQUESTER :  
PHONE:       
DEPARTMENT: MAIL CODE:    FRS #: 
TYPE OF REQUEST
INVENTORY
REQUEST WOULD
Office Supplies New item to stock   Non-stock to stock Duplicate existing product  Standardize
PRIORITY: Essential     Important     Desirable New item non-stock  Vendor direct (Special)Delete product  Vendor change Replace   Add new
Does this item replace or duplicate a current stock item? Yes No     If Yes:  Warehouse #:   Vendor #:

What justifies the introduction of this product?

Please include a written justification for the introduction of this product.  What is it used for, Cost Savings, Improved service, etc.  Include the justification with this form when faxing or mailing to Materials Management.   Fax 679-1218 or Mail: MC2012  email/PDF: Tyler Gawel
Department Manager's Signature: __________________________________________ Date: __/__/__
Description:         Vendor:
Manufacturer:
     Catalog Number:                                          Preferred Unit of Measure:
Available Unit of Measure:
    Price:    Custom Made: Yes No     
Monthly Usage:       Quantity Requested: 
Product Information:
        1.  Is this product department specific: Yes No          If "No", please attach a listing of other units that would use this product.
Materials Management: Supply & Inventory Supervisor (or Designee) Signature: _________________________________________ Date: __/__/__
Materials Manager - Value Analysis Facilitator (or Designee) Signature: _________________________________________ Date: __/__/__
SECTION III: MATERIALS MANAGEMENT USE ONLY
Product should be considered for: Warehouse stock: Prime Vendor: Vendor Direct: Should product be added to the PAR system: Yes No
If PAR or Department Specific: FRS Account Charged: __-__________ Warehouse/PAR Ship-To Account: _________

Warehouse Number Assigned to New Product: _____________ Unit of Issue from warehouse: _________
Director of Materials Management (or Designee) Signature: ____________________________________________    Date: __/__/__

Once completed, please print the form and Fax (x-1218) Materials Management - Value Analysis or Mail MC2012 (FB023)