| Primary Contact Information |
| Institution Name: | Kentucky State University |
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| Primary Contact: | Deneia Thomas |
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| Title: | Asst. Vice President, Academic Affairs |
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| Mailing Address: | 400 East Main Street |
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| City, ST ZIP: | Frankfort, KY 40601 |
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| Phone: | 502-597-5531 | Fax: | |
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| Email: | deneia.thomas@kysu.edu |
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| Send invoices to my attention: | Yes ☐ | No  |
| Billing Information (if different than above) |
| Billing Contact: | |
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| Title: | |
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| Mailing Address: | |
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| City, ST ZIP: | |
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| Phone: | | Fax: | |
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| Email: | |
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| 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: | | |