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.
Approvals:
Date:
Date:
Date:
Item Description
(Model, Size, Color, etc.)
Catalog, or
Part Number
Quantity
Wanted
Unit of
Issue
Cost
Unit Amount
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#):
Phone, FAX #, Email:
Contact Person:
PURCHASE ORDER #
Originator:
Department Chair/Supervisor:
Dean/Manager/Vice President:
BUSINESS SERVICES USE ONLY:
PURCHASE REQUISITION #
Suggested Vendor Information:
Name:
Address:
City, State, Zip:
Total
Shipping
Tax (8.00%)
Sub-Total
Any special installation (electrical, plumbing, etc.) requirements?
Yes No
RS#
Estimate
