Purchase Order Request Form

Please use the form below to submit a District 1199C Training & Upgrading Fund Purchase Order Request. Submission of a Purchase Order Request Form does not guarantee payment.
Please consult with your supervisor to verify payment.

Submitter's (i.e. your) Name*
Date Requested*
This Purchase Order is for:*
Vendor's Address
If different from Vendor Name
Payee Address IF DIFFERENT
To your knowledge, is this a NEW vendor, or one the Training Fund has paid before?
IF NEW VENDOR: Upload IRS Form W-9, if available
No File Chosen
File uploads may not work on some mobile devices.
If available
$
Include GL Code if Known
Upload Supporting Documentation (Invoice, Receipt, etc.)*
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Is this purchase being SHARED ACROSS MULTIPLE GRANTS/FUNDING STREAMS?
A single purchase order may be used to split costs across up to four separate funding sources. However, four copies of the same PO must be saved to the Accounts Payable folder system!
$
$
$
Do you have another item for purchase FROM THE SAME VENDOR & FUNDING SOURCE?
$
Include GL Code if Known
Upload Supporting Documentation (Invoice, Receipt, etc.)
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Do you have another item for purchase FROM THE SAME VENDOR & FUNDING SOURCE?
$
Include GL Code if Known
Upload Supporting Documentation (Invoice, Receipt, etc.)
No File Chosen
File uploads may not work on some mobile devices.
Upload Supporting Documentation (Invoice, Receipt, etc.)
No File Chosen
File uploads may not work on some mobile devices.
Upload Supporting Documentation (Invoice, Receipt, etc.)
No File Chosen
File uploads may not work on some mobile devices.
Upload Supporting Documentation (Invoice, Receipt, etc.)
No File Chosen
File uploads may not work on some mobile devices.
Do you have another item for purchase FROM THE SAME VENDOR & FUNDING SOURCE?
$
Include GL Code if Known
Upload Supporting Documentation (Invoice, Receipt, etc.)
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Upload Additional Documentation (if necessary)
No File Chosen
File uploads may not work on some mobile devices.
Do you have another item for purchase?

Please fill out the form again for additional purchase requests.

$
Request Date*
Use your mouse or finger to draw your signature above
As Executive Director, Teresa Collins is ONLY issuing "Final Approvals." If Teresa is your direct supervisor, please select your own or a peer's name for second-level review.

Second-Level Review (CHECK FOR ACCURACY!)

Is this Purchase Order Request approved?
Program/Departmental Authorization Date
Use your mouse or finger to draw your signature above

Final Authorization

Use your mouse or finger to draw your signature above
Final Authorization Date/Time
: