PURCHASE REQUEST FORM
APROVAL INITIALS
VENDOR CODE: VENDOR: ADDRESS: CITY/ST/ZIP:
DATE:
CHOOSE ONE OF THE FOLLOWING: RX# PV# Document Number: ACCT. #: SHOP/RESP. PERSON: DELIVER TO BLDG/RM: SHOP PHONE #: IDR#
VENDOR PHONE #: VENDOR CONTACT NAME: ORDER TO BE FAXED BY: PLEASE LIST FAX #:
NOTE: Any service request to other departments must be on a IDR. Any Registration, membership , or subscription must be on a PV.
QUANTITY
UNITS
DESCRIPTION
UNIT
COST
** (continue on back if necessary) ** IDR #: COMMODITY CODE: PURPOSE/STOCK: Check all that apply:
Will Call To be delivered Mail LPO To be shipped
TOTAL
BLDG #: RM #: REFERENCE #:
W/O#:
Job to be completed Items to be picked up
Order to be Faxed Items received