Internet Application Form

INTERNET APPLICATION FORM

Note: This form must be filled out for each Internet user (please check the appropriate box)

ÿ New Application ÿ Update

UCLA USER INFORMATION

1.  User name (person who will be entering orders)______

2.  Employee Number______

3.  Address/Room number______

4.  City, State, & Zip______

5.  Mail code______Dept.Name ______

6.  Phone (_____)______Fax (_____)______

7.  E-Mail______

8.  I understand that as a user of the Office Products 2000 purchasing system, I am responsible for assuring that all transactions I process are in accordance with relevant regulatory requirements, UCLA financial policies, and all restrictions particular to the funding source. I understand that I must complete training prior to using the system. User Signature:______Date__/__/__

9.  I understand that I am responsible for monitoring usage of the Office Products 2000 purchasing system to ensure that all transactions processed are in accordance with relevant regulatory requirements, UCLA financial policies, and all restrictions particular to the funding source. I understand that I am responsible for ensuring that each user on my staff completes training prior to using the system.
Supervisor/Manager name (print):______Phone(____)______
Supervisor/Manager Signature:______Date ___/___/____

10.  I understand and assume responsibility for the use of the Office Products 2000 purchasing system by my unit(s) in accordance with the prevailing policies and procedures.
Chief Administrative Officer name (print):______Phone(____)______
Chief Administrative Officer Signature:______Date __/__/__

11. Please provide your MIS help desk phone number (____) ______
Ó Regents of the University of California CONTINUE ON REVERSE

Tab 8 2

PLEASE PROVIDE THE FOLLOWING INFORMATION FOR EACH INTERNET USER

12. USER NAME:______

13. RECHARGE ID NUMBERS Add Del FS DEPARTMENT CODES Add Del.

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14. SHIP TO NUMBERS (Room Numbers/Building Name)

Add Del.

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IF ADDITIONAL SPACE IS NEEDED PLEASE IDENTIFY INTERNET USER AND ATTACH TO THIS FORM.

Please mail completed Application Forms to “Office Products 2000”, Wilshire Center, Suite 800 (Mail Code:139148). Be sure to include one application for each internet user.