IT Purchasing Request

This form is used to initiate an internal purchasing request. Please complete all fields marked with an asterisk and include additional comments as appropriate. All requests will be routed to your director or team leader for approval before processing.

Submitter Information

Name (Required)

Department (Required)

Email (Required)

Phone (Required)

Ordering Information

Vendor Name (Required)

Vendor Address

Vendor Fax Number

Vendor Web Address

If this request is for a single item, please complete all remaining required fields below.
If this request is for multiple items, please describe the nature of the request under item description and send a quotation or list of items to the Director or Team Leader as a separate e-mail.

Item Name or Number (Required)

Item Description (Required)

Quantity (Required)

Price (Required)

Shipping and Handling Instructions

Additional Comments