SOLE SOURCE REQUEST
Sole Source Procurement is appropriate only if a purchase requirement is reasonably available from a
single supplier, or if it otherwise qualifies under the attached sole source definition.
ALL SOLE SOURCE REQUESTS OVER $5,000 MUST BE PRE-APPROVED BY THE
PURCHASING DEPARTMENT.
It is anticipated the procurement will result in a (check one):
___ Contract: E-mail this form to the Purchasing Department prior to contract negotiations; no
requisition is required. Requested contract term (include requested renewal options, if any):
___ Purchase Order: Enter requisition into Banner, insert the requisition number here___________,
send this form to the Purchasing Office, along with a copy of the vendor’s quotation.
_____________________________________________________________________________________
Department Requesting Approval: ________________________________________________
Division or Office, if applicable: __________________________________________________
Contact Person and Title: ________________________________________________________
E-mail Address: ________________________________________________________________
Phone Number: ________________________________________________________________
______________________________________________________________________________
Product(s) or Service to be purchased:
Approximate Cost: $__________________
_____________________________________________________________________________
Recommended Supplier:
Contact Person:
E-mail Address:
Phone Number:
City, State, Zip:
Type of Supplier (check one): ___ Corporation ___ Government
___ Partnership ___ Sole Proprietorship
___ Other
______________________________________________________________________________
