STATE OF CALIFORNIA
INTRA OFFICE REQUISITION


(LOCAL REQUEST)
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Requisition #:
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blue banner gold banner  REQUIRED INFO ABOVE !!!
 
 
see Contracts 
Quantity
Unit
Model or Catalog #
Description
Per Unit
Total
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    see codes
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Shipping/
Handling
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  PeopleSoft Chartfields (* = required)
Account*
Fund*
Dept ID*
Program
Project
Class
% or Qnty
State Contract/SPS / Reference #
___________
PROCUREMENT USE ONLY:
Requisition #
 
 
F.O.B.

___________

Ordered by:


__________

Procurement Approval:


__________

Total after tax: $_______________________

Called in to: ____________________________________________

Delivery Date: __________________________________________

Fax to: ________________________________________________

Fax #: ________________________________________________


Date Faxed: ___________________________________________




I HEREBY CERTIFY on my own personal knowledge that the articles or services requested hereon are necessary for use in my department
PRINTED NAME BELOW




  Signature

_____________________________




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