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Request for Surplus/Scrap Form
Department Information:
Department Code:
*
Contact Name:
*
Phone:
*
Email Address:
*
Preparer Information:
Name:
*
Address:
*
Phone:
*
Email:
* (i.e. xyz123@cornell.edu)
Date Prepared:
*
Equipment Information:
Bar Code/Tag Number:
*
State ID Number:
Item Description:
*
Manufacturer:
*
Model:
*
Serial Number:
*
Acquisition Date:
*
Condition Code:
*
Scrap/Surplus:
Request Type:
Surplus
Scrap
*
Reason for Scrap/Surplus:
*
Expected Price
*
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