Information Technology Services Purchase Requisition Form
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1Information Technology Services
Purchase Requisition Form
VENDOR
SHIPPING ADDRESS
Vendor: ____________________________________
The Pennsylvania State University
Contact:____________________________________
ITS Unit: _____________________________________
Address: ___________________________________
Contact: _____________________________________
City/State/Zip: ___________________ /___ / ______
Address: _____________________________________
Phone #: _________________ Fax: ______________
City/State/Zip: ____________________ / ___ / _______
Date Needed: _________________________________
Qty
Part/Catalog #
Description
Unit Price
Extended Cost
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total Estimated Cost
Purpose/Project:
Special Instructions:
Attach Sole Source Justification Form if applicable
Approvals:
________________________________________
____________
______________
Requested by:
User Id:
Phone #:
_________________________________________________________
___________________
Approved by:
Date:
_____________________________________________________
___________________
Funding Approval:
Date:
Budget Information: Complete below as appropriate
Date Ordered:
IBIS Doc #:
P #:
Cardholder Signature:
Date:
If Credit, Original P#:
Reconciler’s Initials:
Date:
If Duplicate Charge, Original P#:
Credit to Correct Duplicate P#:
Budget
Fund
Obj Code
Amount
Cost Center
Sub Object
10010
10010
10010
10010
Free Space:
Description:
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Parent category: Business