Surplus Request Form

Please Note: SWAP only picks up items from UW Departments and Local State Agencies
See Purchasing Policy and Procedures #18 for further information

Is this a Pick-Up or a Drop-Off? Pick-Up Drop-Off (Please submit this form at least 24 hours before dropping off your items) Online Auction - Items on Location
Please complete all information below or your form will not be processed.
Contact Name:
Phone number:
E-mail:
Department:
Building Name/Street Address and Room Number:
Location of items (if different from above):
MDS Account Number: (required)
The University can only return the net proceeds from the sale of these items to your department if the following statement is true: The assets being sold were originally purchased with grant or gift funds, OR the assets being sold are being replaced, OR they have recently been replaced, OR the functionality has been replaced. True False

Description of Equipment

Qty.	Description of Equipment	Description of Equipment Condition	Mfr's Serial / UW Inventory Number	Suggested Current Value	Originally 144 Funds (Y/N)
					No Yes
					No Yes
					No Yes
					No Yes
					No Yes
					No Yes
					No Yes
					No Yes
					No Yes
					No Yes
					No Yes
					No Yes

Additional Comments:

I understand that I am fully responsible for identifying each asset purchased with grant or gift money and that I am required to provide any University of Wisconsin asset decal numbers, equipment serial numbers, and ALL FEDERAL IDENTIFICATION numbers regardless of the original purchase price. Any potential funds returned to the department that have been sold through Surplus With A Purpose (SWAP) are the responsibility of the department to determine where those funds are to be ultimately returned to.

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