Campus Labs Billing Information Form
Relevant Information for Procurement/Finance
| Primary Contact Information | |||
| Institution Name: | Kentucky State University | ||
|---|---|---|---|
| Primary Contact: | Deneia Thomas | ||
| Title: | Asst. Vice President, Academic Affairs | ||
| Mailing Address: | 400 East Main Street | ||
| City, ST ZIP: | Frankfort, KY 40601 | ||
| Phone: | 502-597-5531 | Fax: | |
| Email: | deneia.thomas@kysu.edu | ||
Send invoices to my attention:  No ☐ | |||
| Billing Information (if different than above) | |||
| Billing Contact: | |||
| Title: | |||
| Mailing Address: | |||
| City, ST ZIP: | |||
| Phone: | Fax: | ||
| Email: | |||
| Will Campus Labs be issued a PO for this requisition? | Yes ☐ | No  | |
| Is a Campus Labs invoice required for PO generation? | Yes  | No  | |
| PO number is provided: | |||