East Allen County Schools
Purchase Requisition
No.____________
_________________________
School or Dept.
_________________________
Date
TO:__________________________________________ Classification: (Check One)
ADDRESS: ____________________________________ ____Supplies/Materials
City: ________________________________________ ____Services
SHIP TO: _____________________________________ ____Property/Equipment
HOW SHIP____________________________________ ____Repairs/Maintenance
DATE SUPPLIES ARE NEEDED _____________________ ____Rentals
ITEMS TO BE USED AT:__________________________ ____Communications
____Other
Account Number:
Fund Index Object Location
_______New ______Replacement
The following equipment and/or supplies are requested. Please indicate catalog or identification
number when applicable
Quantity
Catalog Number
Description
Unit Price
Requisition by: __________________________________________
Approved by: ___________________________________________
Goods Received by: ______________________________________
EACS F-4 For approved by State Board of Accounts for East Allen County Schools
2/19 ®
04/25/2019
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
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