Purchase Requisition
Suggested Sources- Name and Address of Vendor From Division and/or Department
Date of Requisition
Circle below where items are to be delivered by college personnel
BT SSC HA HO HU
SW MO OR PE Library
Newburgh (OTHER)
(Room Number)
Quantity Dept-Acct #
Activity
Code
Unit Price Extension
Indicate Other Information Helpful to Purchasing Department- (catalog and page number * Items packed per carton or container, etc)
Requisitioned By Division and or Department Approval Date Approved
Date Items Required
This form should be typewritten or printed legibly and sent to the purchasing department. A purchase order will be issued from
the purchasing department only. Do not order any items direct from any vendor.
Note: This is not a purchase order. Do not send this form to any vendor.
Description of Items
(Name of Person Authorized to sign for items delivered)