Complete this form and return it to the Finance Committee’s box.
Date:
Amount of Purchase:
Budget to be Charged:
Make Check Payable To:
Description of Product/Service:
Signature of Department Head requesting purchase
Approved:P.O.#
Postponed: Resubmit:
If funds are available in the budget and if money is available to pay for the purchase, an approved Purchase Order will be issued to cover the requested purchase.