"*" indicates required fields Submitter Full Name*Submitter Email* Purchase Type*AdvertisingBookMembership or Subscription RenewalOffice SuppliesCateringGift CardsPayment Requests (PIR/DP)Software & LicensesTechnical EquipmentOtherDate Required MM slash DD slash YYYY Other Purchase Type*Project/Operational Area* WIDA Other STOP! Technical equipment or services for WIDA must be purchased by WIDA's Operational Tech Support Specialist. WIDA staff must submit purchase requests for technical equipment or services using the WIDA Intranet's General Support Request. Email widaitinternal@office365.wisc.edu with questions about technical equipment or service requests for WIDA.Vendor Information*Name *WebsiteContact Person Add RemoveDescription & Order Details*Description of the item and Manufacturer #, Confirmation or Registration #Order Information*Use the +/- to add or remove rows. All fields are required. Enter N/A for columns which do not apply. Please reference the approved computer and peripherals list.Qty.UnitProduct/Model, ISBN#DescriptionUnit PriceRow Total (Qty. x Unit $) Add RemoveCost*Est. Grand Total*Does this request include a computer?* Yes No Additional Assistance?Recipient(s)*Full Name of person/people who will use the items in this order.List of Payees*Full Name of person/people who will be receiving this payment/gift cards.Was the service performed in the United States?* Yes No Is the payee a non-resident alien (NRA)?*Non-resident alien information Yes No Justification*Describe the purpose of the purchase and provide detailed explanation of who, where, when, how and why it will benefit the project and/or department.PDF of invoice, quote, or other documentationAccepted file types: pdf, Max. file size: 2 MB. Do not upload files that contain sensitive information. Multiple files? Combine into 1 optimized PDF prior to uploading. Files will not be saved if using Save and Continue Later. Funding ApprovalBypass Authorization I am both submitting and authorizing this purchase. No additional authorization is required.Split Funding (must total 100%) Funding for this purchase should be split across 2 accounts.Funding Notes Due to the Workday transition, funding string information (e.g. 133-AAL1234) has shifted to Cost Centers and Driver Worktags (e.g. Cost Center ID: CC001234 and Driver Worktag ID: PG000012345). You can use either funding string or Workday Cost Center and Driver Worktags during this transition phase. Use this crosswalk tool to start getting familiar with your new Workday IDs. Here are instructions for using the crosswalk tool. Fund #*101116131133135136144150161233Funding Information*Authorizer's Name*Authorizer's Email* Authorizer's SignatureSUBMITTER: Leave this field blank unless you are authorized to sign for purchases. Authorizer will be emailed a request to sign off on the purchase. AUTHORIZERS: Sign in the box below:Percentage*Fund #*101131133135136144150161233Funding Information*Authorizer's Name*Authorizer's Email* Authorizer's SignatureSUBMITTER: Leave this field blank unless you are authorized to sign for purchases. Authorizer will be emailed a request to sign off on the purchase.Percentage*Total Funded Percentage - This field is intentionally hidden with CSS.Funding Certification* I certify that the items requested are allowable, allocable, and reasonable.Is this funding in the last six months of active status?* Yes No