Purchase Request P-Card Order Request
Req # Entered by Date PO #
Vendor Name:
Vendor Website:
Vendor T#:
Yes No
Requested by: Date:
Supervisor Approved Date:
$ Approved By: Date:
The requested items will be used for:
Program
Arkansas Tech University
Ozark Campus
Special Instructions:
Agency Funds?
Index Fund Organization Account
Subtotal
Shipping and Handling
Grand Total
Rate %Tax
Quantity Unit Price Total CostsDescription (Item Number):
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
10.50%
$0.00