campuslabs Data Driven Innovation Campus Labs Billing Information Form Revelant Information for Procurement/Finance

Primary Contact Information

Institution Name: Kentucky State University

Primary Contact: Deneia Thomas. PhD Title: Asst. VP, Academic Affairs

Mailing Address: 400 E. Main Street Frankfort, KY 40601

City, ST ZIP:

Phone: 502-597-5531 Fax: 502-597-6409

Email: deneia.thomas@kysu.edu Send invoices to my attention: Yes □ No □

Billing Information (if different than above)

Billing Contact: Title: Mailing Address: City, ST ZIP: DENEIA M. Thomas Assoc Up Academic Assort. D Evo Kentucky State University HOE MAIN STREET, 202 Hamey Hall Frankfort, Key 40601

Phone: 559 75531 Fax: 502-597-6409 Email: deveria.thomas@kepw.edu

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:

T: 716.270.0000 F: 716.652.2689

Campus Relations Contact: Andrew Lyle

www.campuslabs.com

210 Ellicott Street, Suite 200 Buffalo, NY 14203