Hardware/Software Purchase Application Instructions If the pre-tax purchase price of this product exceeds $20,000, please submit a requisition and contact the Procurement Office regarding the bid process before submitting this form. Please refer to the Arkansas Tech Software/Hardware Purchasing Best Practices to verify your need for this form. Respond with N/A (Not Applicable) if the information does not apply to your purchase. All applications are due one month prior to purchase. Requestor InformationName *Building and Room *Phone *Email *Department * Software Section (If Applicable)Software Title Version Who will use this software? Check all that applyFacultyStaffGraduate AssistantsStudentsPurpose How many computers (not including labs) will use this software? Where are these computers located? Which (if any) lab(s) will use this software? Is there a contract or agreement required to purchase this software? YesNoNot SureWill this software require ID card swipe or other hardware? YesNoIf yes, what specific hardware is needed? Hardware Section (If Applicable)Type of Hardware Model Number Will this equipment be used to process credit card transactions? YesNoNot SureWhat (if any) other automatic data transfer will this hardware be expected to perform? Vendor Contact InformationVendor Name *Contact Name *Contact Phone *Contact Email *Website *Does the vendor have a Voluntary Product Accessibility Template (VPAT)? *YesNoNot Sure What is a VPAT? Consideration for persons with disabilities Arkansas Tech University is committed to making reasonable accommodations for disabled persons in response to Section 508 of the Rehabilitation Act of 1973. Please be prepared to make alternate arrangements for any staff, faculty, or student with disabilities that may limit or prohibit the use this product. Initial Cost *Maintenance Fees Subscription Fees License Renewal Fees Describe the recurring costs in terms of future payment schedules. Funding Source DepartmentalFoundationGrantOtherDesired Method of Payment Requisition or Purchase Order Number Is this a P-Card Transaction? *YesNo VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: