PURCHASE REQUEST

OD#4-purrequest.doc 10/2001

Fill in all requested information, no exceptions.
Requests will not be considered or processed without the proper information.
Total all items for each purchase request used.

Date of Request:_____________ Approved by:_______________________________________

Teacher’s Name: ____________________ Date: _____________________________________

Subject: _______________________________________________________________________

Account #: Circle or highlight appropriate number

11-190-100-610/640 Regular Ed	11-204-100-610/640 SC/Special Ed	*610 General Supplies
11-401-100-610/640 Co-Curricular	11-000-213-610 Nurses	*640 Textbooks
11-000-222-610/640 Media Center	11-000-219-610 Child Study Team
11-213-100-610/640 RC/ICS	11-000-216-610 Speech
11-190-100-340 Distance Learning

Vendor: complete name and address

_________________________________________________ Year of Catalogue______ ________________________________________________________________________ ________________________________________________________________________
Qty	Catalogue #	Pg #	Item	Cost per Unit	Total













				Subtotal
				Add 10% if not Current Catalog
				10% Shipping Cost
				Total Cost

Rationale for purchase of item:_____________________________________________________

____________________________________________________________________________