2. Administrative Services PO Acquisition Form

4. All Requests for Purchase must be approved in advance.

6. Date of Submission*
   Date of Submission
7. Type Purchase *
   -- Select One --VendorCredit CardInternetMissing Receipt
8. Emergency Purchase?
   -- Select One --YesNo
10. Name*
11. Title*
12. Department*
14. Email Address*
16. Purchase Date
    Purchase Date
17. County PO
18. Amount of Purchase *
20. Purpose of the Purchase?*
22. Vendor Information: Including address, store, website,ect..*
24. Description of Items Purchased:*
26. Total Amount Charged (including shipping and handling)?*
27. Account Number (GL) to be Charged?*
29. Purchased By?*
30. Approved By?
32. Supporting Documents:

    Include Digital receipt: Scanned Image or PDF File

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field