PURCHASE REQUEST FORM
Complete this form for all purchases of goods & services that do not qualify for direct
pay processes via check request, reimbursement, P-Card, STLS, or other methods
Instructions: For institute or trust accounts, substitute "Program" or "Principal Investigator" with "Account" or "Account Holder".
How to submit completed form: Complete fields below and attach any quotations, budgets, or other pertinent information
Submit Forms to Research and Sponsored Programs: mark.vidal@csueastbay.edu
1. Program Name
rincipal Investigator/Dep
Delivery Address
Telephone
Account Fund Dept ID Program Class Project
Equipment Good Service Subcontract Other
Contact Person
Address
Telephone/Fax/Email
Website
Qty Unit Price Total
1.
2.
3.
4.
5.
Purchase Order Total
(before tax & shipping)
5. Required Delivery Date (enter due date for item delivery or period for provision of services)
7. Sole Source
8. Required Quotes
Purchase order total below $5,000: attach one written price quote from vendor.
REV. 7/19
2. Item Type
Program Chartfield
6. Program Benefit
3. Requested Vendor
Unless No. 7 above is completed, for purchase order total $50,000 or greater, do not obtain price quotes. The
University will handle the solicitation process pursuant to open competition requirements.
4. Requested Item(s)
Describe item or service. Include manafacturer, model #, size, color, or other pertinent
specifications and attach vendor quote for each item. For services, attach a complete
statement of work specifying deliverables and due dates
PI Signature/Approval Date ORSP Signature /Approval Date
Unless No. 7 above is completed, for purchase order total between $5,000 - $49,999
: attach three written price quotes
from three different vendors.
Provide reason why other vendors cannot be considered for this procurement:
If item(s) is/are not specifically identified in approved budget, explain how this purchase benefits the program:
