Account Number:
Project Description:
Completion Date:
Project Location:
Building:
Room:
Contact Person:	(please print)
Extension:
E-mail:

APPROVAL: (all forms must be approved by the Associate Vice President for Facilities)

Project Manager    ________________________________________

Assoc. V. P. for Facilities    ________________________________________

To be completed by Inventory Control:
Date form received:		Date entered into Fixed Asset System:

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