AP-102 RF Form

Please complete the following information as soon as the goods, or services related to the purchase order have been received. Payment can not be made to the vendor until Award Management Services is specifically notified that the items have been received in good condition and that the items received meet the purpose of the related purchase order.

Most vendors require payment within 30 days. Failure to complete the form timely may result in a 'credit hold', which will effect the entire University's ability for future purchases

PURCHASE ORDER INFORMATION LOG

Vendor Name:               

Purchase Order #:          *

Date Received:               *

Item Description:         

 PAYMENT AUTHORIZATION

Acceptor's Name:       

Phone:                           *

E-Mail:                        *

Was Order Complete:  YES     NO *

Process Payment:        YES     NO *

If no, please specify in box below.

If the shipment was received in part, or if anything was damaged, or there are Any other discrepancies, please indicate in the following space, What Should Not Be Paid at this time and specify Why payment Should Not be made for each item. Payments will not exceed quality, and/or price as stated on the purchase order.

*If The required fields Are Not Completed, The Form Will NOT be Forwarded To AMS.

Please contact the Research Funded Purchasing Office if you have not received a copy of your RF Purchase Order

Please click the Send Form button only once. If you do not see an acknowledgement right away, please wait two minutes before clicking Send Form again.