Capital Expenditure Request Form

Download a blank fillable Capital Expenditure Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Capital Expenditure Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

CAPITAL EXPENDITURE REQUEST FORM
BUDGET NO.
DATE:
BUDGET DESCRIPTION:
REQUESTED BY:
DEPARTMENT NAME:
Replacement Equipment ?
Yes
No
DEPARTMENT ACCT:
If no:
CER AMOUNT:
Revenue Generating?
Yes
No
SOURCE OF FUNDS:
If yes attach proforma.
(list ALL sources)
If recommended for lease rather than purchase, check box
and complete and attach explanation and evaluation.
BRIEF PROJECT DESCRIPTION AND JUSTIFICATION
EFFECT ON OPERATIONS
List all other costs associated with the approval of this request such as additional staffing, maintenance agreements, supplies, etc..
COMPLETE THIS SECTION FOR ALL EQUIPMENT REQUESTS
Number of Units
Manufacturer
Model Number
VICE PRESIDENT APROVAL
Approved by:_________________________________________
Date:_________________
TO BE COMPLETED BY FINANCE
PROJECT CATEGORY
Budget Amt.
CER Amount
Date
/
/
Approved
Professional Fees
CAC:
/
/
Approved with
Construction
Modification
Equipment & Furniture
/
/
Disapproved
Permits & Fees
Project Administration
Other C&D
Comments:
Pre CER Expenditures (CIP)
Capitalized Interest
Land Purchase
Other (Non-C&D)
$
$
TOTAL PROJECT COST
REVIEW AND APPROVAL
Date
Date
CFO
CEO / COO
Date
Date
MATERIALS MANAGEMENT
HOSPITAL INFORMATION SYSTEMS
Date
CONSTRUCTION & DESIGN
BIOMED
Date
Date
LEGAL REVIEW
FINANCE RELEASE OF FUNDS

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Capital Expenditure Pre-approval Request Form - Arizona Department Of Education Capital Expenditure Pre-approval Request Form - Arizona Department Of Education Legal
Capital Credit Claim Form Capital Credit Claim Form Legal
Expenditure Report Form Expenditure Report Form Legal
Form Ict-4-x - Amended Electricity Distribution And Invested Capital Tax Return Form - Illinois Department Of Revenue Form Ict-4-x - Amended Electricity Distribution And Invested Capital Tax Return Form - Illinois Department Of Revenue Financial
Form Cms-20027 - Medicare Redetermination Request Form, Form Cms-20034 - Request For Medicare Hearing By An Administrative Law Judge Etc. Form Cms-20027 - Medicare Redetermination Request Form, Form Cms-20034 - Request For Medicare Hearing By An Administrative Law Judge Etc. Medical
Request, Replace, Or Deactivate Nys Fuel Credit Card Request Form - New York Office Of General Services Request, Replace, Or Deactivate Nys Fuel Credit Card Request Form - New York Office Of General Services Legal
Form Ams-15 - Organic Exemption Request Form - 2007 Form Ams-15 - Organic Exemption Request Form - 2007 Business
Request Form For Medical Services And Acknowledgement Of Receipt Of Notice Of Health Information Privacy Practices Request Form For Medical Services And Acknowledgement Of Receipt Of Notice Of Health Information Privacy Practices Business
Request Form For Deferment Of Repayment - Federal Perkins Student Loan Request Form For Deferment Of Repayment - Federal Perkins Student Loan Financial
Request Form For Confidential Filing Of Address Request Form For Confidential Filing Of Address Legal

Related Categories

Parent category: Legal
Download
Go