Purchase Order Commitment

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					         PURCHASE REQUEST                                                       PURCHASE / CHECK REQUEST FORM
         MARK THIS BOX TO HAVE A PURCHASE ORDER ISSUED                                 THIS IS NOT A PURCHASE ORDER
         CHECK REQUEST                                                                UNIVERSITY OF DAYTON                                    REQUISITION NO.   PURCHASE ORDER NO.
         MARK THIS BOX TO HAVE A CHECK ISSUED                                   TO:   PURCHASING DEPARTMENT
                                                                                      DAYTON, OHIO 45469-1664
NAME OF VENDOR / CHECK PAYABLE TO:              VENDOR I.D. NO.                        DELIVERY DATE:                                            SEND CHECK TO:


STREET ADDRESS                                                                        []   HAVE NOT CONTACTED VENDOR [ ] PRICES ESTIMATED        ADDRESS / ZIP+4

                                                                                      [ ] HAVE CONTACTED VENDOR        [ ] PRICES ARE EXACT
CITY, STATE, ZIP CODE                                                                                 [ ] PRE-PAYMENT REQUIRED                   EXPLANATION:

                                                                                       A COMMITMENT MAY NOT BE MADE TO A VENDOR
TELEPHONE                         FEDERAL I.D. NO./SOCIAL SECURITY NO.                WITHOUT PRIOR AUTHORIZATION FROM PURCHASING.
                                                                                      ATTACH COPY OF ALL QUOTATIONS OR LIST VENDORS
 (   )                                                                                CONTACTED IN NOTES SECTION BELOW.
DELIVER DEPT.                          BLDG/ROOM NO.                    ZIP+4         DOCUMENTATION ATTACHMENT(S)
TO:
                                                                                      [ ] FORM [ ] LETTER    [ ] INVOICE [ ] RECEIPT
 ITEM    QUANTITY    DESCRIPTION OF ITEM (PROVIDE CATALOG NO., TYPE, MODEL, SPECIFICATIONS, ETC.) / PURPOSE OF CHECK ( EXPLAIN IN DETAIL)         PRICE            EXTENSION

                                                                                                                                                                               0.00
                                                                                                                                                                               0.00
                                                                                                                                                                               0.00
                                                                                                                                                                               0.00
                                                                                                                                                                               0.00
                                                                                                                                                                               0.00
                                                                                                                                                                               0.00

                                                                                                                                                                               0.00

                                                                                                                                                                               0.00
                                                                                                                                                                               0.00
                                                                                                                                                  TOTAL                        0.00
NOTES:                                                      SIGNATURE OF INITIATOR                        ZIP +4       PHONE EXT. DATE          ACCOUNT NO.        AMOUNT


                                                            CONCURRENCE(S)

                                                            A
                                                            P     SUPERVISOR(S)                                                     DATE
                                                            P
                                                            R
                                                            O
                                                            V
                                                                                                                                    DATE
                                                            A
                                                            L                                                                                  TOTAL AMT           $            -

                         FORWARD TWO COPIES TO PURCHASING DEPT., ST. MARYS 403, (+1664). DEPARTMENT RETAINS ONE COPY.

				
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posted:7/29/2011
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Description: Purchase Order Commitment document sample