Department Name:

Name of Person completing this form:

Receiver Document Code:

Purchase Order Number AND Vendor Name:

Is this order related to a Professional/Consulting Services, Participant, Lecturer, or Other Contract?
Yes No

NOTE: If you answered yes to the previous question, you must answer the next two questions.
     1) Indicate invoicing needs:
      Contract requires an invoice (invoice will be forwarded by the department to Accounts Payable)
      Contract does not require an invoice

     2) Is this contract funded by a grant?
      Yes No

     NOTE: If you answered yes to the previous question (Is this contract funded by a grant?), you must complete the next two items.
          Enter the Contract #:
          Enter PI/PD Email:

 

RECEIVING INFORMATION FOR ABOVE PO# - BY LINE ITEM

PO Line Item#	Qty Rec'd	Rec'd Date	Other
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)
			Please Select Accepted Damaged Wrong Item Other (explain below)

Explanation of 'Other' Entry above:

RECEIVING INFORMATION FOR ABOVE PO# - ENTIRE ORDER ONLY

Entry here means that ALL items on the PO# are Received, Accepted and OK to Pay.

Receive All       Rec'd Date