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									               PURCHASE REQUISITION


               Company Name                PR No. _______

         PURCHASE REQUISITION              Date: ________


Requesting Department: ________________________________

Item #   Qty      Ref #   Description      Purpose Price /
                                                   Unit




Deliver to: ____________________________   Required date of
                                           delivery
                                           _______________

Suggested Suppliers:
_________________________________          Signed
_________________________________
_________________________________          Approved

								
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