Surplus Request Form

Please Note:


This is a:





Please complete all information below or your form will not be processed (all fields required):

Requestor Name:
Requestor Phone Number:
Department:
Requestor email:
Building Name/Street Address/Room #:
MDS Account Number:
MD
Location of Items (if different from address):


The University can only return a portion of the net proceeds from the sale of these item(s) to your department if one of the the following statements is true:
The assets being sold were originally purchased with grant or gift funds, are being replaced, have recently been replaced, or the functionality has been replaced.



Quantity   Description of Equipment   Make/Model   Condition/Functionality   MFR Serial #
(Not needed for supplies <$250)
Conforms to Material
Acceptance Guidelines

Additional Comments:

  I understand that:

Please print a copy of this form for your records and press SUBMIT.