FORM DOT-35 West Virginia Department of Transportation
(12/98) Page of
PURCHASING REQUISITION & CODE SHEET
PURCHASE REQUISTION/ PUR. CHANGE VENDOR
(REMIS) REMIT PAYMENT TO: MAIL ORDER TO:
ORG. NO. PURCHASE NO. TYPE ORDER #
(ORG) (FY) (NUMBER) (ALPHA) Name: Name:
DATE DESCRIPTION Address: Address:
F.E.I.N. CK. BR. STATE CONTRACT NUMBER City: City:
State: Zip: State: Zip:
AUTHORIZATION ACT. OBJ. N EXPENSE
REC. ORG OR E.D. NO. CODE CODE P EDIT ORIGINAL AMT. ADJUSTED AMT. TOTAL AMOUNT
DOT CONTRACT MODEL/PART/ DOT INVENTORY OVER LINE ITEM ACCOUNTING OVERRIDE PURCHASE
LINE LINE REFERENCE TICK RUN REC. AUTH. N EXP. UNIT QUANTITY UNIT COST
ITEM# ITEM NO. NUMBER CLASS TYPE SUBCODE REQ. % ORG. OR E.D. # ACT. OBJ. P EDIT MEASURE 000 0000 TOTAL
$0.00
DESCRIPTION:
$0.00
DESCRIPTION:
$0.00
DESCRIPTION:
$0.00
DESCRIPTION:
$0.00
DESCRIPTION:
$0.00
DESCRIPTION:
$0.00
DESCRIPTION:
$0.00
DESCRIPTION:
RECOMMENDED BY: 1. DATE 2. DATE 3. DATE
APPROVED BY: DATE APPROVED:
TERMINATED BY: TERMINATION DATE: ENTERED BY/DATE: