Request Name
Requestor
Requestor's Email
Is the requisition amount over $10,000?
$10,000 or Less Req. Select your Department:
$10,000 or Less Req. Information Technology (IT) Department Only: Does this req. require IT Supervisor Approval?
$10,000 or Less Req. Engineering Department Only: Does this req. require Engineering Supervisor Approval?
$10,000 or Less Req. Operations Department Only: Does this req. require additional Supervisor Approval?
$10,000 or Less Req. Executive Department Only: Select your Position Title
NOTE: You will need to approve your own Req. Once submitted you will receive an email with approval instructions.
Over $10,000 Req. Select your Department
Over $10,000 Req. Information Technology (IT) Department Only: Does this req. require IT Supervisor Approval?
Over $10,000 Req. Engineering Department Only: Does this req. require Engineering Supervisor Approval?
Over $10,000 Req. Operations Department Only: Does this req. require additional Supervisor Approval?
Transaction Type
Original PO Number
Original Agreement No.
On-Call Agreement No.
Request Date
Ship to
Shipping instructions
If shipping elsewhere is necessary, specify here
Start Date
End Date
Vendor Information
Accounting Unit
Account
Sub Account
Activity
Account Category
Additional Accounting codes ?
Percentage allotment (e.g. 50%, 75%)
Subtotal
Tax
Shipping Quote
Total
Original Contract Amount
Amendment Amount
Revised Contract Amount
Original Purchase Order Amount
Revision Amount
Revised Purchase Order Amount
Engineer’s Estimate/Budget Limit
Please provide a brief explanation as to the reason and/or purpose for this procurement.
Attach:
Attach any other relevant document