| Block # |
DESCRIPTION/EXPLANATION: |
| 2 |
Account number of department placing order. |
| 4 |
Amount to be charged to account number shown in box 2. |
| 5 |
Check here to indicate supplies and expense or equipment items on the same requisition. |
| 6 |
Check here to indicate if applicable. |
| 8 |
List here special attachments, documents. |
| 10 |
Federal Identification number of selected vendor. |
| 11 |
Federal Identification number of second selected vendor. |
| 12 |
Federal Identification number of third selected vendor. |
| 13 |
Vendor name, address and zip code. |
| 14 |
A second suggested vendor name, address and zip code, if known. |
| 15 |
A third suggested vendor name, address and zip code if known. |
| 16 |
Telephone number and Fax number of vendor if known. |
| 17 |
Telephone number and Fax number of 2nd vendor, if known. |
| 18 |
Telephone number of Fax number of 3rd vendor, if known. |
| 19 |
Name, building and room number where ordered items are to be delivered. |
| 20 |
Phone number of ordering department. |
| 21 |
Authorized signature of charged account shown in box 2. (If more than one account is being charged, authorized signatures must be shown on the attachment submitted which lists the additional accounts.) |
| 24 |
State term contract commodity group number, if known. |
| 25 |
State term contract number, if known. |
| 28 |
Name of person that the requisition will be sent to, when completed. |
| 29 |
Department name. |
| 30 |
Building room and number. |