PURCHASE REQUEST FORM
Date sent to Purchasing: PR Ref #:
Date Received by Purchasing:
Part I- Requested by: Title: Tel. Ext:
Dept. / College:……………………………………………………… Building: ….….…..
Purpose of Item(s):…………………………………
Special Instructions: ………………………………..……………………………………………………………………………………………
Available at: ………………………………………………………………………………………………………………………Tel #: ………………
Item Qty/Pcs Stock # Description
1
2
3
4
5
6
7
8
Part II- Authorization :
Head Of Department: Signature: ……….…………………. Date: ………….……...
Printing Materials Approval: Signature: ……….…………………. Date: ………….……...
Concerned VP: Signature: ……….…………………. Date: ………….……...
Part III- Purchasing Process:
Purchase Order #: ………………………………………….. Date: ……………………..
Delivery Date: ………………………………………………. Received by: ………………………………………………………………
Material Approved by Receiver: YES….. NO….. Reason if Material is not Approved: …………………………………..
Part IV
Academic Year: ………………………………………………
Account Name:……………………………………………….. Account Number:…………………………………………………………
PR- Version 1, Sept.. 2015