1) Requisition Number

2) Requisitioning Department

3) Shaded Area for Purchasing Use Only

4) Vendor Name and Applicable Contact Information

5) “Ship To” & Delivery Information: Generally, the “ship to” will be Central Receiving (check “other” if item(s) should be delivered to alternate address); “Deliver To” should indicate the employee, department and location where the item(s) should be delivered once received by Central Receiving.

6) Please check one of the following for proper payment:

• Mail check with PO
• Return PO & Check to Dept.
• Return PO to Dept.

7) Insert all pertinent information about your order, including full descriptions, account number, quantity, unit, unit price, subtotals and totals. Please do not forget the shipping costs.

8) Print Requisitioner’s Name and Extension

9) Authorized Signature and Date

10) Signature of Director of Purchasing

11) Insert any special instructions, such as fax numbers, or "Confirmation of Order"

ADDITIONAL INFORMATION:

• Return white copy to the Purchasing Department. Retain yellow copy for your records.
• Object Codes
• Supplemental Purchasing Requisition