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Purchase Requisition Form Instructions

Our Requisition Form may be saved to the hard drive.

Save this form to your hard drive: Click file Click save as Save to file (ex. program files or my documents) on C drive Name the file (ex. purchasing requisition form) Click the save button May be used repeatedly without retyping all information.

All Appropriate fields and signatures MUST be completed prior to submission of a purchase request.  Failure to complete this form will result in the requisition being returned to the requestor.

Submitted by: (ex. person who completes form with a contact phone ext.)

Date: Today’s date

Order Department Information

(Examples of Accounting Information)

Fund Code: 10000
Department No: 5920000
Program No: 16300
Class No: 11000
Project/Grant No: all grants have a 3 digit project number with)
Account No: 714100 (supplies & materials)

Note: The above accounting numbers may vary in relationship to each department.  Please review the Chart of Accounts for departmental accounting information. The account codes will also vary with item(s) purchased.

Vendor Information

These fields must be completed for processing of the purchase requisition. (these are examples.)

Vendor: Dell Computers
Address: Dept 40228 Atlanta, GA 31192
Contact Phone: Business number 1-800-555-1212
*Vendor Fax No: 1-800-322-5212
City/State/Zip: Austin, Texas 77322
*SSN: Social Security Number: (ex. performance fee required for payment.)
*FEI: Vendor Federal Identification Number: (ex. 58-1234567)

Items Requested (Attach all Supporting Documentation ex. E-Quotes, specifications)

Line Quantity Description Unit Cost Total Cost
1 2 Dell Latitude Notebook Model # XX5972 1,500 $3,000

Comments (ex.) Please deliver to R M Jones STC 219

Signatures Requestor(s) Approval: Individual requesting order

Note submitted by and requestor may/may not be the same individual. Departmental Approval: Head of Department, Supervisor, or Dean of School Additional Approval: (ex. Person in charge of project such as grants)

OITS Approval: All computers, software, hardware peripherals must be supported by the HUB.  Forward all related requests to the Director of OITS for approval prior to final submission to Purchasing.

Media Approval: All audio/visual requests must be approved by Director of Media Services, prior to final submission to Purchasing.