Fillable MiniPORequestForm - PUR-09 Mini Purchase Order Request Form

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MiniPORequestForm - PUR-09 Mini Purchase Order Request Form

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Form:PUR‐09 Page1of2 RevisionDate:07/01/2019
MINIPURCHASEORDERREQUESTFORM
RequestorInformation
NameofPersonSubmittingRequest: Date:
Department: Index|Account:|
VendorInformation
Name:
Address:
City,State,Zip:
EstimatedCost:
Purpose: Description:

RequestorCertification
Icertifythattheaboveinformationis
accurateandisneededtosatisfytheneeds
thedepartment.
RequestorSignature Date

RequestingAuthorities
DirectorSignature:____________________________________________________Date________________
AdministratorSignature:________________________________________________Date________________

APPROVALS
Approved/Disapproved:________________________________________________Date_______________
GrantDirector|GrantAccountant
Approved/Disapproved:________________________________________________Date_______________
ChiefProcurementOfficer
Approved/Disapproved:________________________________________________Date_______________
VPofAdministrationandFinance
Form:PUR‐09 Page2of2 RevisionDate:07/01/2019
INSTRUCTIONS│MINIPURCHASEORDERREQUESTFORM
**
TheformmustbecompletedusingAdobeAcrobat**
1. CompletetheRequestorInformation
a.
EnteryourName
b.
EntertheDatethisformisbeingcompleted
c.
EnteryourDepartmentname
d.
EntertheIndexandAccountthiswillbechargedto
2. CompletetheVendorInformation
a.
Enterthevendor’scompanyname
b.
Enterthevendor’saddress
c.
EntertheCity,State,andZipCodeforvendor
d.
Entertheestimatedcost
i. Aminipurchaseorderwillnotbeissuedforanypurchasesover$1,500.Iftheestimated
costisgreaterthan$1,500,enterarequisitioninthefinancialsystem.
3. CompletethePurpose
a.
Provideasdetailedadescriptionastothepurposeoftherequest.
4. CompletetheRequestorCertification|Signanddate
5. HaveyourDirectorandAdministratorsignanddateunderRequestingAuthorities.
6. Approvals|TheMini‐PurchaseOrderRequestFormmustbesignedbythe:
a.
GrantDirector&GrantAccountant–onlyforrequeststhatwillutilizedGrantFunds
b.
ChiefProcurementOfficer
c.
ChiefFinancialOfficer
Contact:Purchasing(4042)
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MiniPORequestForm - PUR-09 Mini Purchase Order Request Form

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Completed 4 January 2020

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