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It Purchase Requisition document sample
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PURCHASE REQUISITION WEST CONTRA COSTA UNIFIED SCHOOL DISTRICT PURCHASING
SCHOOL OR DEPARTMENT NAME REQUESTING PERSON EXT: REQUISITION NUMBER
REQUISITION DATE DATE WANTED DELIVER TO (Include Zip Code) FOR PURCHASING USE ONLY
IN ORDER TO PROCESS YOUR ORDER, THIS SECTION PURCHASE ORDER #
MUST BE FILLED OUT COMPLETELY NAME NAME
ORG KEY OBJECT CODE
SECOND QUOTE
ADDRESS (Include Zip Code) ADDRESS (Include Zip Code)
VENDOR 1
PROPOSED USE
PROGRAM DESCRIPTION
Phone: Quotations By: Phone: Quotations By:
CHECK Instructional Non-Instructional Fax: Fax:
VENDOR 1 VENDOR 2
Line
Quantity Unit ONLY PROVIDE FULL DESCRIPTION: CATALOG OR STOCK NUMBER, SIZE, COLOR, ETC.
UNIT PRICE TOTAL PRICE UNIT PRICE TOTAL PRICE
1
2
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APPROVALS DATE I certify that the above expenditures comply with the statutes and regulations of the above SUB-TOTAL SUB-TOTAL
funding source(s) and that these expenditures will be used exclusively for those purposes.
PREPARED BY
SALES TAX SALES TAX
Program Justification:
PRINCIPAL OR DEPARTMENT HEAD
SHIPPING SHIPPING
CHARGE CHARGE
REGIONAL SUPERINTENDENT
TOTAL TOTAL
BUSINESS OFFICE
Signature of Fund Manager (Restricted Funds) Date This is NOT a Purchase Order
677807 Rev. 7/01 vlc
PURCHASE REQUISITION - CONTINUATION pg. 2 West Contra Costa Unified School District PURCHASING
SCHOOL OR DEPARTMENT NAME REQUISITION DATE REQUISITION NUMBER
PAGE 2 OF PAGES (ENTER SITE CODE)
VENDOR 1 VENDOR 2
Line
Quantity Unit ONLY PROVIDE FULL DESCRIPTION: CATALOG OR STOCK NUMBER, SIZE, COLOR, ETC.
UNIT PRICE TOTAL PRICE UNIT PRICE TOTAL PRICE
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677807 Rev. 7/01 vlc PAGE TOTAL AUTOMATICALLY ADDS TO SUB-TOTAL ON PAGE ONE PAGE TOTAL
PURCHASE REQUISITION - CONTINUATION pg. 3 West Contra Costa Unified School District PURCHASING
SCHOOL OR DEPARTMENT NAME REQUISITION DATE REQUISITION NUMBER
PAGE 3 OF PAGES (ENTER SITE CODE)
VENDOR 1 VENDOR 2
Line
Quantity Unit ONLY PROVIDE FULL DESCRIPTION: CATALOG OR STOCK NUMBER, SIZE, COLOR, ETC.
UNIT PRICE TOTAL PRICE UNIT PRICE TOTAL PRICE
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677807 Rev. 7/00 vlc INCLUDE THIS PAGE TOTAL IN THE SUB-TOTAL ON PAGE ONE PAGE TOTAL
PURCHASE REQUISITION - CONTINUATION pg. 4 West Contra Costa Unified School District PURCHASING
SCHOOL OR DEPARTMENT NAME REQUISITION DATE REQUISITION NUMBER
PAGE 4 OF PAGES (ENTER SITE CODE)
VENDOR 1 VENDOR 2
Line
Quantity Unit ONLY PROVIDE FULL DESCRIPTION: CATALOG OR STOCK NUMBER, SIZE, COLOR, ETC.
UNIT PRICE TOTAL PRICE UNIT PRICE TOTAL PRICE
33
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677807 Rev. 7/00 vlc INCLUDE THIS PAGE TOTAL IN THE SUB-TOTAL ON PAGE ONE PAGE TOTAL
