"Expense Request Form Template"
Capital Expenditure Request & Business Case Worksheet Instructions The Capital Expenditure Request form is required for all capital asset ($5,000 or greater) purchases where title will belong to MCNC. This form is not required for purchases where title will pass to the customer. Proposals of $100,000 or more require a higher level of justification and approval (see Capital Expenditure Request and Major Project Proposal Procedure). Capital Expenditure Request Worksheet: 1. Complete information at top of form (project name, et al). The project name will automatically be entered on the Business Case Financials and Depreciation worksheets. 2. Complete the executive summary. Provide enough detail for the reviewers to understand the nature of the acquisition, why it is necessary, how it will benefit MCNC, the project schedule and financial impact. Also, discuss risks and urgencies and alternatives considered. If the space on the form is insufficient, you may make reference to a supporting write-up and attach it separately. A Word document is recommended. Refer to Capital Expenditure Request and Major Project Proposal Procedure for information requirements for proposals of $100,000 or more. 3. Nature of Expenditure - check the appropriate box or boxes to indicate the type of purchase. 4. Project Financials - most of the information in this section is brought forward automatically from the Business Case Financials worksheet. Enter the useful life of the project or equipment and any headcount changes that will result from this project. The useful life in this section is used by the depreciation worksheet to determine the depreciation rate. Also, indicate in the appropriate space whether the cost was budgeted or not. Business Case Financials Worksheet: This worksheet should be used to summarize the financial impact of the project. In general, costs to acquire and install the asset should be entered in the Capital section in Year 0 and the Profit and Loss Impact should be summarized in Years 1 to 10 (depends on the life of the asset). 1. Revenue - over write the revenue stream lines to list each source of revenue resulting from the investment and enter the amounts in the appropriate years. 2. Headcount expenses - if additional headcount will be required for the project, enter salaries and other expenses directly related to the headcount. Payroll taxes and benefits are calculated automatically based on the salary amount entered. 3. Non-Headcount expenses - over write each line with a description of the type of expense to be incurred and enter the amounts in the appropriate years. 4. Depreciation - do not enter any amounts. Depreciation is automatically calculated and entered. 5. Cost Savings - if any cost savings will result, enter the nature of the savings and the amounts in the appropriate years. 6. Capital - enter the appropriate amounts for acquiring and installing the asset. Salvage value should be entered as a negative amount. 7. Net Cash Flow Impact - is automatically summarized by the spreadsheet. 8. Incremental Headcount - enter the number of full-time positions included in the salaries line under Headcount expenses. 9. Net present value, internal rate of return and the payback period are automatically determined and carried forward to the Capital Expenditure Request worksheet. Depreciation Worksheet: This worksheet requires no data entry. It takes the investment total and useful life from the other worksheets and automatically calculates depreciation expense for entry on the Business Case Financials worksheet. 5169ec85-d21d-4f61-a057-d769a0901282.xls 2/1/2011 Instructions 7:15 PM MCNC Capital Expenditure Request Date: Project Name: Project No.: Project Owner: Dept No.: Project Sponsor: Dept Ops or Direct Project? Physical Location of Asset (MCNC-RTP or off-site?): Executive Summary: Nature of Expenditure - Check " X " all that apply : Equipment Replacement New Service Cost Reduction Enhancement of Existing Service Increased Capacity Health & Safety Strategic Investment Project Financials: Total Budgeted NPV $ - Project (Y/N) IRR - % Capital - Payback Period N/A years Spending - Useful Project Life* 5 years (Disposals) *(i.e. 3, 5, 7, 10 years) Headcount Approvals: Signature Date Project Owner: Director (up to $25K): Controller/Treasurer (All): CEO (>$25K): 5169ec85-d21d-4f61-a057-d769a0901282.xls 2/1/2011 Capital Expenditure Request 7:15 PM Business Case Financials Project: Total Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10 Project Incremental Impacts: Profit and Loss Impact: Revenue: Revenue stream 1 - Revenue stream 2 - Revenue stream 3 - Total Revenue - - - - - - - - - - - - Spending: Headcount expenses: Salaries - Payroll Taxes - - - - - - - - - - - - Benefits - - - - - - - - - - - - Travel & Ent. - All other - Total Headcount - - - - - - - - - - - - Non-Headcount expenses: Expense 1 - Expense 2 - Expense 3 - Expense 4 - Expense 5 - Expense 6 - Expense 7 - Expense 8 - Expense 9 - Expense 10 - Depreciation - - - - - - - - - - - - Total Non-Headcount - - - - - - - - - - - - Net Operating Income - - - - - - - - - - - - Add back noncash expenses: Depreciation - - - - - - - - - - - - Cash Flows from Operations - - - - - - - - - - - - Cost Savings: Benefit A - Benefit B - Benefit C - - - - - - - - - - - - - Capital: Purchase price - - Delivery - All install/other costs - Salvage value - - - - - - - - - - - - - Net Cash Flow Impact: CF from Operations Impact - - - - - - - - - - - - Cost Savings - - - - - - - - - - - - Less: Capital - - - - - - - - - - - - +/- Other Adjustments - - - - - - - - - - - - - - - - - - - - - - - - Incremental Headcount 0 0 0 0 0 0 0 0 0 0 0 NPV $ - IRR 0.0% Payback Period - years Discount Rate 5.0% 5169ec85-d21d-4f61-a057-d769a0901282.xls 2/1/2011 Business Case Financials 7:15 PM DO NOT ENTER ANY DATA ON THIS SPREADSHEET Straight Line DEPRECIATION - used for Calculation only '* Ignores IRS SEC 179 expense deduction Project: Straight Line DEPRECIATION CALCULATION 3-Year 4-Year 5-Year 6-Year 7-Year 10-Year Year 1 0 2 1 33.3% 25.0% 20.0% 16.7% 14.3% 10.0% 3 2 33.3% 25.0% 20.0% 16.7% 14.3% 10.0% 4 3 33.3% 25.0% 20.0% 16.7% 14.3% 10.0% 5 4 25.0% 20.0% 16.7% 14.3% 10.0% 6 5 20.0% 16.7% 14.3% 10.0% 7 6 16.7% 14.3% 10.0% 8 7 14.3% 10.0% 9 8 10.0% 10 9 10.0% 11 10 10.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Straight Line DEPRECIATION CALCULATION for Business Case Year 3-Year 4-Year 5-Year 6-Year 7-Year 10-Year 5 1 0 - 2 1 - 3 2 - 4 3 - 5 4 - 6 5 - 7 6 - 8 7 - 9 8 - 10 9 - 11 10 - - - - - - - 5169ec85-d21d-4f61-a057-d769a0901282.xls 2/1/2011 Depreciation 7:15 PM