The University of Memphis

Contract/Agreement Routing Form

Please click here for form Information & help: Contract Review and Approval Process Summary (opens in a new window)

Requesting Department

Department Name Room/Building
Contact Person Telephone
E-Mail Address Fax

Contractor Information

Contractor Name Telephone
Contact Person
Address Fax
E-Mail Address

Contract Description

Purpose of Contract:
Contract Amount: Start Date:
End Date:
Requisition Number (Required for Expenditure Contracts)
Is this a "Sole Source" contract? N/A (contract <$10K) No  Yes   If yes, justification must be provided
Is your Attestation Re Personnel Used in Contract Performance attached? (Required for Personal Service, Professional Service, Consultant Service Contracts, and all contracts for acquisition of hardware, software and related services) No  Yes
Will any University data be released as a result of this contract? No  Yes
(If yes, appropriate ITS approval required in "Contract Routing and Approvals" section below.)
Will any student information be released as result of the contract? No  Yes
What other departments are affected by this contract?
Specify the individual in your department (Contract Monitor) responsible for ensuring receipt of goods/services contracted for under this agreement:
Specify an Alternate Contract Monitor:
Specify the frequency of monitoring (quarterly, semi-annually, annually, etc.):

Please proceed to this link to complete and submit the Contract Monitoring Plan as proposed.

I certify that I have read the attached contract/agreement and that the requesting department will comply with all its requirements and have notified any other departments affected by this contract/agreement. I recognize that while the Procurement and Contract Services, Business Services, ITS, or the Office of Legal Counsel may analyze the contract from a legal or policy perspective, it is the requesting department's responsibility to (a) ensure the specifications are sufficient and/or practical for department need; (b) funds are available; (c) monitor compliance, expiration, and payment; and (d) ensure no violation of University policies and procedures in connection with this contract, including the policies on UM1692: Conflict of Interest and UM1691: Campus Data Security.
Requesting Department:
Department Contact/Contract Monitor

Approved By:
Financial Manager / Director / Department Chair

Approved By:
Dean/Assistant Vice President (If $50,000 or more)

Approved By:
Vice President / Provost (If $250,000 or more)


Contract Routing and Approvals

Type of Contract (Select One) Routing Sequence Approvals Date
A. Standard Contracts and Vendor-Generated Contracts
Clinical Affiliation
IT Products (Computer Hardware, Software, IT Services, Cloud Environments, etc.)
Services (Banking, Dining, Equipment Maintenance, etc.)
Continuing Education
Dual Service
Facilities Use
Personal, Professional, and Consultant Services

1. Procurement and Contract Services (678-2265)

2. Legal Counsel (if applicable)

3. Business Services (if applicable)

4. ITS (Hardware or Software)

B. Specific Non-Standard Contracts
Music Performance License
Real Property Lease
1. Business Services (678-2307)

2. Legal Counsel (if applicable)

C. All Other Non-Standard Contracts

1. Legal Counsel (678-2155)

2. Business Services (if applicable)

3. ITS (Hardware or Software)

For Office Use Only: Contract Number______________ Purchase Order Number______________