PURCHASE/REQUISITION ORDER

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					NORTH BOLIVAR SCHOOL DISTRICT REQUISITION FORM
                                                            Web Document

SCHOOL/DEPT: Broad Street High School                             REQUISITION DATE: ______________________
                                                                  VENDOR: _______________________________
DELIVER TO: 1305 Martin Luther King Drive                         ADDRESS: ______________________________
            Post Office Box 149                                   CITY: __________________________________
            Shelby, Mississippi 38774                             STATE: _______________________________________
                                                                  ZIP CODE: ____________________________________
                                                                  VENDOR PHONE:
                                                                  VENDOR FAX:
ATTENTION: __________________________
PHONE 662-398-4040   FAX 662-398-5900                             Funding Source: _____/_________/_______/_____________
                                                                                       Fund Function    Object Code Approval


                                                                                                           UNIT             TOTAL
      ITEM                                DESCRIPTION                                  QUANTITY
                                                                                                           PRICE            PRICE




                                                                                                       SUBTOTAL

                   NO BACKORDERS                                                                        SHIPPING

NOTE:
                                                                                                           TOTAL

___________________________________                                  ________________________________________
        Employee’s Signature (Date)                                        Superintendent’s Signature (Date)

_____________________________________                               ________________________________________
         Principal’s Signature (Date)                                     Business Manager’s Signature (Date)


             1.    Submit original to Central Office before placing order (will also be filed with invoice/receiving report).
             2.    Include 2 quotes on vendor letterhead if order exceeds $5000.00.
NOTE:        3.    Submit only on Tuesdays, except in case of emergency.
             4.    Include shipping charges on requisition.
Requested By:                                      Date:



SCHOOL __________________________________DEPARTMENT*______________________
                                                                      (specify)
*   Reading Teacher     * Supervisor                            __________________________
*   CAI Instruction     * English/Lang Arts                            (specify)
*   Staff Development   * Administration                         __________________________
*   Math Teacher        * Other_______________                         (specify)
*   Parent Center




       ________________________________________ Approved by Principal (School Site)
                              Signature



PURCHASE DATA (Circle as applicable):               4. Quotes

     1. No quote/bid necessary                      5. Bid # indicated for items on Bid list

     2. Maintenance/repairs                         6. Emergency purchase (documentation attached)

     3. State Contract                              7. Single source –   single source letter attached with
                                                                         pertinent information needed for
                                                                         board of trustees approval.




PURCHASE ORDER MAILED/FAXED/CALLED IN BY: ______________
                                                                      (initials)

				
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