Purchase Order Request Form - DOC

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Purchase Order Request Form - DOC Powered By Docstoc

The Merchandise Purchase Request Form is used for purchases of goods or services
that cost over $200. The form should be filled out and submitted to the local Regional
Director or department Director who will process the request and if approved, sign and
send it to the Director of Finance. Please wait for verbal or written approval prior to
purchasing the listed item(s). If an emergency repair or a vital replacement is
required, please make attempts to authorize with the Director of Finance or Executive
Director, but authorization is not required to purchase emergency or essential items or
services from a vendor. Nonetheless, please inform the Director of Finance that the
order with the vendor has been placed.

1.  Date- Date request is made.
2.  Person Requesting Merchandise- Staff member requesting item(s).
3.  Vendor- Provide the seller’s name, address, phone and fax number.
4.  Vendor Payment Method- Provide the way in which the vendor requires
    compensation. Will the vendor bill us directly, require payment up front with a check
    or credit card, etc.
5. Office Location- Which ASNC office is requesting the merchandise.
6. Quantity- Number of the items requested.
7. Description- Brief description of the item.
8. Account Code- What ASNC accounting code the merchandise should be billed to.
9. Unit Price- Price per item.
10. Total Price- Price per item times the quantity.
11. Special Requirements/Instructions- Any additional billing information that needs to
    be included that is not listed anywhere else on the form.
12. Total Amount- The sum of all the items requested.
13. Brief Description- Explain why item is needed or what it is used for.
14. Staff Requesting the Purchase- Signature of employee requesting item.
15. Local Authorization by- Signature of approval by the local administrative staff
    member (Regional Director).
16. Administration Authorization by - Signature of approval by Director of Finance or
    Executive Director.
                                     PURCHASE REQUEST FORM

                                 Send completed Purchase Request Form to:
                          Autism Society of North Carolina, Attn: Director of Finance
                      505 Oberlin Road, Ste 230, Raleigh, NC 27605 Fax: 919.743.0208

                      Date                                    Person Requesting Merchandise

                Vendor                     Vendor Payment Method                 Office Location

Quantity                     Description                    Account       Unit Price      Total Price

           Special Requirements/Instructions                    Total Amount

                                Brief Description for the above purchase(s)

                                           Signature Requirements

Staff Requesting the Purchase: ____________________________________________________________
                               Signature                       Title               Date

Local Authorization by:           ____________________________________________________________
                                  Signature                       Title               Date

Administration Authorization by: ____________________________________________________________
                                 Signature                       Title               Date

Description: Purchase Order Request Form document sample