2. Requesting Supervisor*
3. Department*
4. Cell Phone
6. Please select your need

   1. Please TEXT me a PO Number
   2. Please EMAIL me a PO number
   3. PCard Purchase. Please increase my PCard limit for single purchase
8. Vendor*
9. Address (if new)
11. City*
12. State*
13. Zip
15. Vendor Contact
16. Vendor Phone
18. Vendor Email
20. =========================================================================
22. Reason for Purchase*
24. Items You Intend to Purchase
26. Description 1*
28. Quantity*
29. $Each*
30. Total$*
31. GL
33. Description 2
35. Quantity
36. $Each
37. Total$
38. GL
40. Description 3
42. Quantity
43. $Each
44. Total$
45. GL
47. Description 4
49. Quantity
50. $Each
51. Total$
52. GL
54. Description 5
56. Quantity
57. $Each
58. Total$
59. GL
61. Description 6
63. Quantity
64. $Each
65. Total$
66. GL
68. After submitting this request, please submit additional documentation to Purchasing. Include all applicable invoices, receipts and shipping tickets. Reference Purchase Order number if applicable.

70. Purchasing Approval __________________________Date: ________
72. Purchase Order Number: ___________
74. PCard limit increased not to exceed 24 hours: _______
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field