North East School District

TEACHER:

NORTH EAST SCHOOL DISTRICT

BUILDING:

DEPARTMENT:

EQUIPMENT REPLACEMENT

DATE:

SUBJECT:

762

GRADE:

ONE SUPPLIER PER PAGE

CATALOGUE NO & DATE:

Please have requests for audiovisual equipment reviewed by the building librarian.

MANUFACTURER/SUPPLIER – Name:

SUBTOTAL

Address:

HANDLING & SHIPPING

City, State, & Zip Code:

Telephone Number:

Fax Number:

TOTAL THIS PAGE

REQUEST REVIEWED BY LIBRARIAN: ______APPROVED: ______DISAPPROVED: ______DATE: ______

REQUEST REVIEWED BY PRINCIPAL: ______APPROVED: ______DISAPPROVED: ______DATE: ______

NOTE: ALL INFORMATION IS NEEDED IN DETAIL BEFORE ORDER WILL BE PROCESSED.

Two copies distributed following administrative approval/funding.

1. Department Chairperson

2. Teacher

CODE:

Principal Retains Original