Order Form

this order form is only valid for compressed gas orders. All other items should be ordered through the new remote order system.  if you do not already have one, please request a user id and password

This is an electronic order form that will be sent to Central Supply at the University of Maine. Please fill out the following information then submit the form. For Information on Central Supply please contact Paul Kosobud or call (207) 581-2704.

TO BE USED ONLY BY DEPARTMENTS WITHIN
THE UNIVERSITY OF MAINE SYSTEM

DEPARTMENT INFORMATION

       Peoplesoft Chartfields :

Department Name :

Department Addr :  

  Deliver To Addr :  

    Contact Person :       Telephone # :

                   E-mail :  
                     *Email is required (if left blank, your order will not reach Central Supply

CYLINDER RENTAL ORDER FORM

Qty 	UOM        ITEM

 

Special Order Gases

AFFIDAVIT

By submitting this order form, I do hereby solemnly swear or affirm that the information given above is current and true to the best of my knowledge and is in no way misleading. Furthermore, should any data change in the future, I will ensure that correct information will immediately be submitted to the University of Maine, Central Supply

Do you agree to, and understand, all of the conditions and regulations required for on-line ordering? Yes No


By clicking on SUBMIT QUERY your order will be sent electronically to Central Supply. If you wish to clear the data entered above please click on CLEAR FIELDS.

Comments? Send e-mail to Kosobud@maine.edu
 Last Modified June 13, 2007