University of California

Institute for Computational Earth System Science (ICESS)
Preliminary Requisition

Date: Purchase Order No:

Vendor Name:
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Contact:
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Ordered By:
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Approved by: ___________________________________ Date: __________________

Department Approval: ___________________________ Date: __________________

Required Delivery Date:

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     Cost Center:_____________
       Lien Date:_____________
    Invoice Date:_____________
        Invoice#:_____________
Partial/Complete:_____________
            Paid:_____________
  Invoice Amount:_____________
  Use Tax Amount:_____________

FDP Equipment Usage Assurance: The Equipment is used primarily or exclusively in the conduct of the research.

Principal Investigator Signature: X_________________________ Date: __________


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