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STATE OF CALIFORNIA
INTRA OFFICE REQUISITION
(LOCAL REQUEST)
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PAGE-1
Requisition #:
Business Unit:
BKCMP
BKASI
BKFDN
BKSPA
BKSTU
see
instructions
DELIVER TO:
DATE:
Requestor:
Extension:
DATE REQUIRED:
DEPT. NAME:
Requestor Email
REQUIRED INFO ABOVE !!!
COMMENTS:
see
Contracts
Subtotal-Cont
see
Public Works
Subtotal-Public Works
Quantity
Unit
Model or Catalog #
Description
Per Unit
Total
1
Category:
see codes
2
Category:
3
Category:
4
Category:
5
Category:
6
Category:
7
Category:
8
Category:
9
Category:
10
Category:
11
Category:
12
Category:
13
Category:
14
Category:
15
Category:
16
Category:
17
Category:
18
Category:
19
Category:
20
Category:
21
Category:
22
Category:
23
Category:
24
Category:
25
Category:
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add item 15
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add item 17
add item 18
add item 19
add item 20
add item 21
add item 22
add item 23
add item 24
add item 25
Suggested Vendor (Please Specify):
Sub-Total
Shipping/
Handling
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PeopleSoft Chartfields
(* = required)
Fund*
Dept ID*
Account*
Program
Project
Class
% or Qnty
State Contract/SPS / Reference #
___________
PROCUREMENT USE ONLY:
Requisition #
Mail check w/ P.O. and docs
Mail Confirm
Check Request
Debarment Review Required
Total before tax
F.O.B.
___________
Ordered by:
__________
Procurement Approval:
__________
Total after tax: $_______________________
Called in to: ____________________________________________
Delivery Date: __________________________________________
Fax to: ________________________________________________
Fax #: ________________________________________________
Date Faxed: ___________________________________________
P1B
PW
Contract
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
Print name
Signature
_____________________________
Title:
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