Purchase Order And Credit Card Request Worksheet

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Purchase Order and Credit Card Request Worksheet
Please print or type your information! Thank you
Organization Name
Date Received
Event/Program
Date Processed
Contact Name
Document Number
Contact Phone #
Purchase Order Number
Contact Email Address
Pcard Charge Month
Date Needed/Date of Event
Receipt
Yes
No
P.O. __ P-card___ NIU ___ Other ___
Vendor Information
Accounting Data
Vendor Name
Suggested Vendor Code
Vendor Address
GL
City, State Zip
Fund
Vendor Contact
Cost Ctr.
Vendor Phone
Funct.
Web site Address
# of
Reason for the charge/purchase & description of item(s) being
Units
purchased/paid for example; (quotes, confirmations,
QTY
Unit Cost
Total Cost
(each/case)
contracts). Attach any documentation (quotes, confirmations,
$
PLEASE CHECK THE TYPE OF FUNDING BEING USED
UFB PROGRAM/EVENT APPROVED FUNDS ____
Advisor Signature Print
Advisor Signature Sign
(COPY OF APPROVED UFB FUNDING REQUEST MUST BE ATTACHED SHOWING APPROVAL)
$300 OPERATING FUNDS _____ AIC FUNDS____ CLUB SPORTS____STUDENT GOVERNMENT____
UFB EXEC BOARD
Treasurer Signature Print
Treasurer Signature Sign
(ADVISOR/TREASURER SIGNATURE IS REQUIRED)
BEARCAT LIVE____DIVERSITY ED____PAC____
FRATERNITY/SORORITY____LEADERSHIP____
PLEASE READ
NIGHTWALK____RAPP____SAB____SALD____
WORLDFEST____
(ADVISOR SIGNATURE IS REQUIRED)
I understand that if I do not provide a receipt within two weeks of an event, our group will be in
jeopardy of not being able to use the charge card and funds will be frozen for the remainder of the
academic year.

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