BLANKET PURCHASE ORDER REQUISITION (BPOR)
DATE TODAY INITIATING DEPARTMENT
SUGGESTED SUPPLIER CURRENCY: CANADIAN US $ Other - specify __________
SHIP GOODS TO:
Default - Central Receiving, 10 King St, Sackville
If Alternate Location, Identify Bldg:________________________
Goods to be Picked up at Supplier’s Address
SERVICES PERFORMED AT:
The
Supplier’s Address
On Campus, Identify Building:____________________________
TEL FAX
MEANS OF SHIPMENT TO BE SELECTED BY
PURCHASING SUPPLIER
COST OF SHIPMENT
NOT INCLUDED IN PRICES INCLUDED IN PRICES
PO TYPE: (PLEASE COMPLETE)
GOODS ONLY LABOUR ONLY JANITORIAL SERVICE GOODS AND LABOUR RENTED EQPMT WITH OPERATO
TO REQUEST STANDING PURCHASE ORDER or TO CONFIRM AGREEMENT for SERVICES,
MAINTENANCE OR SOFTWARE CONTRACTS
To supply or release of goods or services, maintenance agreements, or software licensing under University Terms and
Conditions.
Description of Goods or Services to be Supplied:
The Department Head or Grantee confirms that the following Person(s) listed below are approved to request supply directly from
the supplier under this agreement:
Show names or attach list: __________________________________________________________________________
_________________________________________________________________________________________________
Related information: Previous BPO # ______________
Supplier Maintenance Agreement or Contract attached YES NO
MtA Professional Services Agreement attached YES NO
Agreement Begins: _____ / _________ / 200__ Agreement Ends: _____ / April / 200__
(Day) (Month) (Year) (Day) (Year)
( Net $ = Net $ x # of months) Net $ _____________ plus HST @ 15% $ ____________ = $ ___________________
DEPARTMENT HEAD/GRANTEE
BUDGET ACCOUNT NUMBER AMOUNT
DEAN OR VP
PURCHASING
FINANCIAL SERVICES TAX CODE PO #
WHSCC CERTIFICATE:
YES NO Not Required
PO TYPE S G L J A R
WHSCC EXP DATE:
100.00
15.00
115.00
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