PURCHASE REQUISITION Use when ordering supplies, equipment or purchase of service Date:                                             To:    Director of Purchasing                                                   From:                                           Phone:                                                                                    Phone                                        DELIVER TO:                                     BLDG/RM #                           EXT                       Item/Catalog No. Order Qty Item Description Unit Price Total Price                                                                                 Shipping and Handling   Total   VENDOR PAYABLE ADDRESS   BUDGET LINE ACCOUNT NUMBER TOTAL FOR ACCOUNT ________________________________       ________________________________       ________________________________       CITY___________________________       STATE______ ZIP ________________       TELEPHONE_____________________       SCLA Director/Asst. Director Signature          Advisor Signature _________________________                             __________________________

------------------------------------------------------------------------------------------------ FOR PURCHASING DEPARTMENT USE ONLY Vendor ID#:________________ PO#_________________DATE:_________________