New E-Way User Request Form for DUHS Forms-Only Account (not Office Supplies)
Please Complete All Required Fields marked with a
*
*
Duke DEMPO ID
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First Name
*
Last Name
*
Email Address
Please make sure the email address is valid.
*
Phone Number
*
Department Name
Billing Information
*
Cost Object Code
For Example: 1234567C, 201234567C
*
Company Code
0010 Duke University
0020 DUHS
0021 Duke Community Infusion
0023 DUHS Equity Investments
0024 PRMO
0026 LABCO
0027 DCC
0028 DHD
0030 Duke University Hospital
0040 DUAP
0050 Durham Regional Hospital
0051 Allied Health Source
0060 Duke Health Raleigh Hospital
0071 Duke Medical Strategies Inc
0080 MSO (PDC)
Ship-To Information
*
Building/Facility Name
*
Street Address
Please verify that this information is entered correctly.
*
City
*
Zip Code
*
Room/Floor
Exact delivery location, please be specific.
Comments or Special Instructions
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