UNIVERSITY OF THE VIRGIN ISLANDS



Department Head



Number



Distribution: No.

WHITE — Purchasing

YELLOW — Department

PURCHASE REQUISITION Page of

Recommended Vendor(s): Department Requisition Number

Date

Required Delivery Date

DELIVER TO

For Purchasing Office Use Only ;

Location

Attention:

For Purchasing Office Use Only

YES NO

Bids ? C7 fo

Quotations ? fo |

Vendor Number Confirming: Phone (|

Ship Via Wire £7 \checked By

FOB Point Other LT] | Purchase

U5. Fon Date Order No.



[Terms: _ Not Confirming ai . -

item Unit of Description Est. Unit Estimated

No. Quantity Measure iGive complete & detailed Specifications} Price Total



intended Use ESTIMATED TOTAL



————

Name of Department

To Be Charged



This [J One Yr lam Budget |_!ndex Fund Oran | Account Prog



Requisition fi 6 mos One time Code an



Covers Our : aa) Purchase



Need For: £]  3mos. urenas Account Name.



For Accounting Use Only



Requisitioned By Approved



Budget Approval:



i PP Encumbrance