NORTHWESTERN ATHLETICS
REQUEST FOR PURCHASE ORDER
Date / 7/24 / Team/Department / Mountain BikingRequested by / Peter Douglas
Chart String(s)
$
$
Fund / Dept / Project / Activity / Program / CF1 / Account / Amount
VENDOR INFORMATION Deliver purchase to:
Anderson Hall (2701 Ashland)
Equipment Room (2703 Ashland)
Facilities Office (1501 Central, Gate M)
McGaw Hall (2705 Ashland)
Nicolet Football Center (2707 Ashland)
Patten Gym (2407 Sheridan)
South Ryan Field (1501 Central)
SPAC (2379 North Campus Drive)
Training Room (2703 Ashland)
FEIN / 98764321Name / Cycling Pro Shop
Addresss / 14 Mountain Road
Hills, NJ 01010
Contact Person / Matthew
Vendor’s phone / 111-222-3333
Vendor’s fax / 111-222-4444
Vendor’s copy of purchase order
Fax to vendor
Mail to vendor
Do not send out
Delivery date: / Jan / - / 25 / -Month / Day / Year
Purpose of request:
New tires for mountain bikes to begin spring training*Federal Employer Identification Number required for all new vendors
PLEASE FOLLOW INSTRUCTIONS BELOW
1. Get a purchase order before making purchases
2. Complete all information on this form
3. The Equipment Manager must sign all requests for purchases of team equipment. Department heads must sign all other requests.
______
Revised 05/06 Authorizing Signature & Date
REQUISITION FORM
6 / ea / A12 / 14" Aluminum front tires / $150 / $900
4 / ea / A16 / 14" Aluminum back tires
with 6 speed gearbox / $200 / $800
12 / set / U45 / Wheel mounting kits / $10 / $120
Total Cost: / $1,820