Form 1 - Purchase Request Form
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1FORM 1 - 2017/2018
For Office Use Only:
Date:
DO NOT STAPLE
STUDENT SERVICES, INC.
Signed:
BUSINESS OFFICE
MILLERSVILLE UNIVERSITY
MILLERSVILLE, PA 17551
ORGANIZATION:
DESCRIPTION
DATE:
or EVENT :
Authorized Signature:
Advisor Signature:
Please issue a CHECK in the amount of
$
Invoice #
OR
A PURCHASE ORDER in the amount of
$
Quote #
Make check
W-9
payable to:
Recepients
LEGAL Address:
City
State:
Zip:
PLEASE DISTRIBUTE FUNDS AS FOLLOWS:
PLEASE DEDUCT FUNDS FROM:
PICK UP CHECK
ALLOCATED ACCOUNT
MAIL TO LEGAL ADDRESS
FUND RAISER ACCOUNT
FOR SSI INTERNAL USE
MAIL TO ALTERNATE ADDRESS AS WRITTEN BELOW:
FOR SLI INTERNAL USE
STREET
CITY/STATE/ZIP
CODING:
GI#
ACCT #
FOR OFFICE USE ONLY
DATE ENTERED:_______________ BY:________
DATE RCVD: _________________ BY:______
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Parent category: Business