STATE UNIVERSITY OF NEW YORK						PURCHASE REQUISITION FORM
(UNIVERSITY-WIDE ADMINISTRATION)							C2573-684


A copy of the form will be returned for					Date: May 6, 2009
your files after assignment of PO #.					Purchase Order No.:  


All requests for the purchase of equipment, supplies or repairs must be forwarded on this form.  If you already have 
price quotations and/or descriptive literature in your possession, please attach them.


Vendor(s):  			

Name

Address





Contract # 

Group #


Orig. Agency Code	SUNY Account		Sub		Object		Estimated FY Cost




DESCRIPTION OF SERVICES				QUANTITY	UNIT	UNIT PRICE	AMOUNT













										TOTAL:


Name of Person Using Items				Exact Date Items Needed


Department or Office


Building and Room Number				Signature of Chairman or Administrative Officer