Purchasing Request Form

Please fill out all the fields below and click on the submit button

Name: E-Mail:

Date:

Does your manager know about this purchase? Yes No

If No, what is the purpose of this purchase?

Priority of purchase: High Medium Low

Item Description:

Item's Justification:

What is it for:

What service does this purchase support?

INFR/TSOP Number:

Is it a renewal? Yes No

If yes, dates of renewal:

Will it need renewal or maintenance someday? Yes No

Quote:
N/A
I'll Submit it Later
Vendor will fax it
Included (please see below)

If quote is included please paste it here:

Does quote include shipping/freight charges? Yes No

Budgeted Cost (supplied by supervisor)

Estimated Cost (supplied by quote)

If different why?

If applicable, have you notified OSS about this purpose with regard to sparing?
Yes No N/A

Special Notes: