Purchase Requisition Blank Form by alicejenny


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Requisition No.                Account FOPAL

Requisition Date               Account Index No.
                                                                    Page______ of______                        Draft Requisition
                               Fiscal Year
Requestor Name:                              E-Mail                             PO Vendor Number (if known)    Vendors Name                                    Mandatory (Y/N) Attachment (Y/N)

Requestor Dept.                              Phone            Fax               Prior PO (if known)            Address                                          Federal Tax ID#
                                                                                                                                                                or S.S.#:
                                                               (313) 577-8061

Internal Delivery Address (if applicable)                                       Required Date:                 City, State Zip                                  Telephone:
 351 Student Center                                                                                            (if not USA)

Department Contact Person                                                       Quote Number (if applicable)   Quoted by (Name)                                 Quote Date:
                                             (313) 577-1010
                                                                                                               (Quote or Contract must be attached)

                                               Unit                                      Vendor Part No.
 Line     Required                                     Cmod                                                                                           Unit    Discount
                             Quantity           of                                    Description/Comments                                                                        Total
 No.        Date                                       Code                                                                                           Price    Factor
                                               Meas.                               Line Distribution Accounting

                                                              Choose One:

                                                                                                                                                                              Total Amount
Departmental Approval:                                                                    Comments/Special Instructions:

NOTE: Items in bold must be completed

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