UNIVERSITY LIBRARIES

PURCHASE REQUEST FORM

(Items NOT Stocked by Storekeeper)
Date:
 
Time:
 
Name of Person Ordering:
Phone Number:
 
Department:
 
Alternate Contact Person:
 
Phone Number:
 
Deliver to Person:
 
Room Number:
 
 
Is this a CAPITAL EQUIPMENT purchase:(check one) YES NO DIVISION:
Description of items: Include cost or estimate. If from catalog or web please attach copy of page showing item(s); catalog number, size, color, wood type, web address, etc.; catalog year and title. Use additional pages, if necessary. PLEASE ONLY ONE VENDOR PER FORM.
QUANTITY
ITEM DESCRIPTION
SIZE
COLOR, WOOD TYPE, CATALOG NUMBER, ETC.
UNIT COST
TOTAL COST
Addt'l Info.:
Suggested Vendor:
Phone Number:
Address:
Justification:

   
Department Head Signature Date Signed
   
Associate Director Signature Date Signed