______________________________________________________________________________________
Vendor Name
______________________________________________________________________________________
Address
____________________________________________________________ ______ _________________
City State Zipcode
________________________________ __________________________________________________
(Area Code) Phone Number CONTACT PERSON
2003-06-27
ST. THOMAS UNIVERSITY
PURCHASE ORDER REQUEST
FOR INTERNAL USE ONLY
NOT AUTHORIZED FOR PURCHASING
ORIGINAL DATE:
This order must be filled within:
7 days 14 days
21 days 30 days
OTHER SPECIAL HANDLING REQUIREMENTS
Have competitive bids been obtained for this purchase
And is documentation available? Yes No If this item was not approved as part of your original budget,
THIS SECTION MUST BE COMPLETED please attach justification for this purchase request.
GEN. LEDGER ACCOUNT DESCRIPTION
Item Line Dept. Code and Vendor Item # Qty Price Total Cost
Total
Dept. Manager Approval:________________________ Purchasing Office Approval:_____________________
Dept. Head signature(if required):_____________________ Budget Office Approval: _____________________
(For AP Department use only)
Voucher No.__________________
Purchase Order No.____________
Check No.___________________
Voucher Date_________________
