UPMC Hillman Cancer Center Service Agreement Request Form

Use this form to request the purchase of any service agreement costing $2,000 or more.

Please provide at least 30 days notice to process this request.

The Hillman Operating Budget assures that all expenditures for service agreements are based upon carefully planned institute-wide programs for development. Major Expenditure is defined as any service agreement that costs $2,000 or more.

Instructions for Completing and Submitting Form

  1. Please complete Sections I-IV.
  2. Please submit the completed form electronically and as a hard copy:
    • Electronic Submission:
      • Submit the completed online form below.
      • After submitting the online form, a PDF of the submitted information will be emailed to the address you provided. Save and print the entire PDF to use for the hard copy submission.
    • Hard Copy Submission:
      • Obtain any applicable required attachments as noted in Section IV of the form.
      • Signatures in Section V of the printed form are not the applicant's responsibility but this page must be included with the hard copy submission.
      • Send the printed form and all applicable attachments to:
        Joan Neitznick
        Administrator for Basic Research
        Suite 1.25
        Hillman Cancer Center Research Pavilion