SAN DIEGO MESA COLLEGE
SUPPLY & EQUIPMENT REQUISITION
Department Date:
Deliver to (Room # & Contact)
Budget Number Actual Date Needed
Requestor’s Name Telephone #/Email address:
A.
Prepare a separate form for different vendors.
B.
The form must be filled out completely, including
unit price, total cost, shipping, tax, etc.
C.
Attach quotes or other pertinent information.
D.
Maintain a copy and forward original to
Department Chair or Supervisor then to Dean, VP
or Manager
E.
Forward the original to Business Services, A-102
This form contains formulas to calculate
extensions, sales tax and totals.
Cost Item
Description
(Model, Size, Color, etc.)
Catalog,
or Part
Number
Quantity
Wanted
Unit
Unit Amount
Suggested Vendor Information: Sub-Total
Name:
Address: Shipping
City, State, Zip:
Phone, FAX #, Email:
Contact Person:
Total
Any special installation (electrical, plumbing, etc.) requirements?
Yes No
RS# Estimate $
If yes, please explain installation requirements.
If this item(s) is/are to be installed in an existing piece of equipment, please provide the District’s equipment identification number(s),
(EQ#):
Approvals:
Originator: Date:
Department Chair/Supervisor:
Date:
Dean/Manager/Vice President:
Date:
BUSINESS SERVICES USE ONLY: PURCHASE REQUISITION # PURCHASE ORDER #
