2. Credit Card/Internet Purchase/Missing Receipt 

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

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

    Include Digital receipt: Scanned Image or PDF File

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field