Palo Verde College
OneCollegeDrive–Blythe,California–Phone(760)921‐5500–Fax(760)922‐0230
PURCHASEREQUESTFORM
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. BusinessOfficeApproval‐Required
5. Placeorder‐AdministrativeServicesDepartmentwill
placeorderunlessotherarrangementsaremade.
QTY ITEM# DESCRIPTION UNITPRICE TOTAL
FUND SCHOOL RESOURCE PY GOAL FUNCTION OBJECT AMOUNT$ SUBTOTAL
S&H
TAX
TOTAL
BRIEFEXPLANATIONFORREQUEST:
FORBUSINESSOFFICEUSEONLY:
BUDGET: APPROVED_____
DENIED_____
DATE__________
___
INITIALS_______
___
REASON_______________________________________________
PO#_______________
CC________________