University of Alaska Kenai Peninsula College
Procurement Office
PURCHASE REQUISITION
156 College Road
THIS IS
NOT
A PURCHASE ORDER
Soldotna, Alaska 99669 Tel: (907)262-0310
Shaded Portions are for Procurement Use Only. DATE
KPC
SHIP TO:
Dept. Phone No.
Date Items Needed
Ship VIA
Phone No.:
SUGGESTED SUPPLIER(S):
TO:
DELIVERY DATE BID/QUOTE NO. SHIP VIA F.O.B. TERMS P.O. NO.
BUYER:
ITEM
COMPLETE DESCRIPTION QUANTITY
UNIT
UNIT PRICE TOTAL PRICE
TO BE USED FOR:
Send Dept. Copies of P.O. to:
GRAND TOTAL:
ACCOUNT NUMBER
ACTION REQUESTED
APPROVED DISAPPROVED
ITEM FUND
ACCT
AUTH. AMT. PURCHASE ORDER
CHECK REQUEST
CASH PAY P.O.
PROCARD
SPEC. PROC.
EMERGENCY*
Confirming P.O. No._____________
FEDERAL GRANT OR CONTRACT NO.
MODIFICATION
To P.O. No.____________________
Requisitioned by:________________________________________________
Signature Date
* Attach justification
Approved by:_________________________________________________
Budget Approval:________________________________________________
Signature Date
Signature Date
I approve this purchase and certify that property has been screened
Procurement Officer
for campus/statewide availability by University property regulations.
Approval:______________________________________________________
Signature Date
Revised on: 6/4/13
Shipping:
ORG
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