Shipping & Receiving Dept., Ext. 8803, Room L.381

Storeroom Supply Request

Submit completed form to the Business Office or OSR for final approval
(Prices effective 2/28/2012 - Prices subject to change without notice)

REQUESTOR DATE
 ROOM
 DEPARTMENT
ACCOUNT # (10-00-000000-163456-60604 )
 AMOUNT
 APPROVED BY
ACCOUNT # (10-00-000000-163456-60604 )
 AMOUNT
 APPROVED BY

Misc. Supplies
Qty. Description Pkg. Price Ext. Price
 Paper, Copy 8.5 x 11 case $32.80 $
 Cups, Paper Hot 8oz 50/tube $2.20 $
 Kleenex
Kleenex		 box $1.21 $
 Paper Towels, C-Fold case $17.24 $
 Surge Supressor each $16.34 $
 Acrylic Poster Stand each $7.58 $
 Hand Sanitizer each $1.59 $
 Box, records retention 1.2 cft. Each $1.90 $

Duracell/Procell Alkaline Batteries
 AAA 4/Pack $0.74 $
 AA 4/Pack $0.75 $
 C Each $0.46 $
 D Each $0.56 $
 9v Each $0.88 $

Scantron Exam Sheets
 Exam Sheet, Red #72946 100/Pkg. $12.57 $
 Exam Sheet, Green #89003 100/Pkg. $11.32 $
 Exam Sheet, Red #103251-2 100/Pkg. $17.00 $
         

Lab Supplies
Qty. Description Pkg. Price Ext. Price
 Bleach 1Gallon $2.39 $
 Sharps Container, Quart Each $1.18 $
 Sharps Container,Gallon Each $2.79 $

 

        

Ethyl Alcohol
 190 proof gal $12.19 $
 200 proof gal $12.44 $
         

Microflex Powder-Free Exam Gloves (10 Boxes=1 Case)
 NeoPro Chloroprene, XS 100 / BX $7.89 $
 NeoPro Chloroprene, S 100 / BX $7.89 $
 NeoPro Chloroprene, M 100 / BX $7.89 $
 NeoPro Chloroprene, L 100 / BX $7.89 $
 NeoPro Chloroprene, XL 100 / BX $7.89 $
 FreeForm SE Nitrile, XS 100 / BX $8.69 $
 FreeForm SE Nitrile, S 100 / BX $8.69 $
 FreeForm SE Nitrile, L 100 / BX $8.69 $
 FreeForm SE Nitrile, XL 100 / BX $8.69 $

Order Total $

RECEIVED BY:
DATE: