UT Math Purchase Request Form

Today's Date: 09/24/2023

Name:   Title:
EID:   E-mail:

Account to be Charged:   Date Item Needed: 

Is purchase an IT item?   Yes    No

Is purchase a furniture item?   Yes    No

Will delivery or assembly of item be requied?   Yes    No

Estimated cost of item: 

Please give detailed description of the item requested, including location and item numbers if known.

Notes: Please include any additional details, including statement of purchase justification if required.

Office Use
Date received:  Date fulfilled: 
Total Charge:  UT Tag: 
DeeDee Number:  Misc 1  
Misc 2: : Misc 3: 

Please type the characters you see in the picture above