This form is to be completed by the employee requesting an Independent Contractor for services as part of the Purchase Requisition process. Before submitting, the Contractor must complete Section one and Section two, items 1 & 2. The person requesting the services must complete the third section clarifying the service being requested.

Section four is generally N/A.

The contractor must print their name and ID information and sign the document. It must also be signed by the Department Director.