Appendix A

MOU Item Identification and Valuation Form

Please use this form to enter detailed information and valuations for items stored under MOU contract at the MDS General Warehouse.

Email

This field is for validation purposes and should be left unchanged.

UW Madison Department(Required)

MOU Number(Required)

This number can be found at the top of your executed MOU contract with MDS and should be formatted (20XX-XXX)

Name(Required)

First Last

Email(Required)

Stored Items at MDS

Item Description

Manufacturer/Make/Model Info (if known)

Quantity

Replacement Value (Total)

Maximum number of entries = 5. If you need to enter more items, please fill out additional forms.