PURCHASE REQUEST
NUMBER: COM CODE
NUMBER:
ACCOUNT NUMBER OBJECT CODE
CITY STATE ZIP
FAX:
FED ID
QUANTITY
UNIT DESCRIPTION OF ARTICLE:Include Manufacturer, Model Number UNIT PRICE TOTAL
Color, Size & Other Specifications Necessary for Identification
Originator's Signature Date
Approval(s) Date
SUGGESTED VENDOR
DEPARTMENT/PROJECT
ADDRESS
Mia
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signature
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signature
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Page 2 of Purchase Order Number______________________________
QUANTITY
UNIT DESCRIPTION OF ARTICLE:Include Manufacturer, Model Number UNIT PRICE TOTAL
Color, Size & Other Specifications Necessary for Identification