Palo Verde College
OneCollegeDriveBlythe,CaliforniaPhone(760)9215500Fax(760)9220230
PURCHASEREQUESTFORM
VENDOR:REQUESTOR:
NAME:
NAME:___________________________DATE:____________
ADDRESS:
SUPERVISORSIGNATURE:
CITY/STATE/ZIP:
VICEPRESIDENT’SSIGNATURE:
PURCHASEREQUESTPROCEDURE
1. Completeorderdetails‐Attachcopyofallpertinentinformationneededforordering:Vendorinformation,
pricing,copyofcatalogue/webpage,shipping,orderform,etc.
2. Provideabriefexplanationforrequest.
3. VicePresidentApproval‐Signaturerequired.
4. BusinessOfficeApprovalRequired
5. PlaceorderAdministrativeServicesDepartmentwill
placeorderunlessotherarrangementsaremade.
QTY ITEM# DESCRIPTION UNITPRICE TOTAL
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FUNDSCHOOL RESOURCEPY GOAL FUNCTION OBJECT AMOUNT$ SUBTOTAL
  S&H
  TAX
  TOTAL
BRIEFEXPLANATIONFORREQUEST:
FORBUSINESSOFFICEUSEONLY:
BUDGET: APPROVED_____
_
DENIED_____
_
DATE__________
_
___
_
INITIALS_______
_
___
_
REASON_______________________________________________
_
PO#_______________
_
CC________________
_
$0.00
$0.00
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