LODI UNIFIED SCHOOL DISTRICT
PURCHASE ORDER REQUISITION
SUGGESTED SUPPLIER (VENDOR)
Requisition No.
SCHOOL OR DEPARTMENT
ATTENTION/MARK FOR: DATE
PROGRAM TO BE CHARGED SHIP TO: (If different than above)
Qty Description Catalog No. Unit Price Extension
COMMENTS/SPECIAL INSTRUCTIONS Subtotal
Shipping
Tax
Total
INSTRUCTIONS
1. Each requisition is limited to one vendor.
2. Submit on this form, printed on BLUE paper.
3. If additional space is needed, complete additional pages.
4. Do not use this form for personal reimbursements.
Requested by Date
Approved by Date
Approved by Date
Program Administrator Date
Director of Purchasing Date
Exceeding Signature Date
Page 1
Budget Code(s)
Fund – Resource – Year – Goal – Function – Object – School – Mgmt %
DO NOT WRITE BELOW THIS LINE
TO BE COMPLETED BY BUSINESS SERVICES
Approved for Budget by Date
Vendor Number
Deliver To:
F.O.B. D or S
Purchase Order Number
Rev 10/02
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Reset Form
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome