Shop@UW – UW–Madison

Contact Information

Name*

First Last

Phone*

Email*

What department are you with?*

What MD number are you using?*

What items are you providing?*

**Please do not use parentheses**

Item Name / Description	Brand / Model # / Size (if applicable)	Quantity

Are these item(s) a donation?*

You selected no, please tell us what item(s) you would like replaced once the University returns to normal operation.*

Were these items purchased with federal funds?*

You selected Yes, please tell us which item(s) were purchased with federal funds.*