ARIZONA DEPARTMENT OF ADMINISTRATION
SPECIAL SERVICES DIVISION
SURPLUS PROPERTY MANAGEMENT OFFICE
1537 WEST JACKSON STREET – PHOENIX, ARIZONA 85007-3215
602-542-5701
Pre-Authorization to Purchase Form
This form is to be filled out prior to coming to Surplus Property. The intention of this form is to
expedite the invoicing process.
Authorized Signer
Name: ____________________________
Email Address: ____________________________
Donee #: ____________________________
Agency Name: ____________________________
Function Code: ____________________________
Blanket PO #: ____________________________
Pre-Authorization
____________________________ has pre-authorization to purchase:
With a dollar limit of: $ ____________________________
Signature of Authorized Signer: ____________________________
Date: ____________________________
This pre-authorization will expire 30 days from signed date.
This Pre-Authorization to Purchase Form grants limited proxy to sign the Transfer Document
and Invoice on behalf of the Authorized Signer.
click to sign
signature
click to edit
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