Purchase Request Form

"*" indicates required fields

Please Select a Department*

Customer Support

Educational

Human Resources

Marketing

Professionals

Repairs & Maintenance

Research

Supplies

Quality Control

Is this purchase for your own department?

Site/Zone*

Location/Site*

Name*

First Last

Email*

Department Needing this Purchase*

Suggested Vendor*

Select other if not in list.

Other*

Payment Method*

Type of Supply*

How many unique items to purchase?*

Quote

Drop files here or

Max. file size: 15 MB, Max. files: 5.

Please upload the associated quote.

1st Item – to purchase*

1st Item – Reason for purchase*

1st Item – Cost*

1st – Quantity*

Please enter a number from 1 to 1000.

2nd Item to purchase*

2nd Item – Reason for purchase*

2nd Item – Cost*

2st – Quantity*

Please enter a number from 1 to 1000.

3rd Item to purchase*

3rd Item – Reason for purchase*

3rd Item – Cost*

3rd – Quantity*

Please enter a number from 1 to 1000.

4th Item to purchase*

4th Item – Reason for purchase*

4th Item – Cost*

4th- Quantity*

Please enter a number from 1 to 1000.

5th Item to purchase*

5th Item – Reason for purchase*

5th Item – Cost*

5th- Quantity*

Please enter a number from 1 to 1000.

6th Item to purchase*

6th Item – Reason for purchase*

6th Item – Cost*

6th- Quantity*

Please enter a number from 1 to 1000.

7th Item to purchase*

7th Item – Reason for purchase*

7th Item – Cost*

7th- Quantity*

Please enter a number from 1 to 1000.

8th Item to purchase*

8th Item – Reason for purchase*

8th Item – Cost*

8th- Quantity*

Please enter a number from 1 to 1000.

9th Item to purchase*

9th Item – Reason for purchase*

9th Item – Cost*

9th- Quantity*

Please enter a number from 1 to 1000.

10th Item to purchase*

10th Item – Reason for purchase*

10th Item – Cost*

10th- Quantity*

Please enter a number from 1 to 1000.

Does this purchase require shipping?*

Estimated Shipping Cost*

Enter your total shipping cost for the above item(s)

Please be sure you have the correct GL code. Please use the General Ledger Dictionary to confirm.

Customer Support GL Coding

GL Coding Number*

Stockyard – Customer Support

GL Coding Number*

Easton – Customer Support

Educational GL Coding

GL Coding Number*

Stockyard – Educational

GL Coding Number*

Easton – Educational

Human Resources GL Coding

GL Coding Number*

Stockyard – Human Resources

Marketing GL Coding

GL Coding Number*

Stockyard – Marketing

GL Coding Number*

Easton – Marketing

Professionals GL Coding

GL Coding Number*

Stockyard – Professionals

GL Coding Number*

Quality Control GL Coding

GL Coding Number*

Stockyard – Quality Control

GL Coding Number*

Easton – Quality Control

Repairs & Maintainance GL Coding

GL Coding Number*

Research GL Coding

GL Coding Number*

Stockyard – Research

Supplies GL Coding

GL Coding Number*

ASM Code

Estimated Total Cost

Additional Notes

Because this request is outside of your department, it must be approved by department budget holder.*

First Last

Email for the department head*

Supervisor Name / Approver Name*

First Last

Supervisor Email / Approver Email*

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