PURCHASE REQUEST & APPROVAL FORM Form Code: HSW-F32

 HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM

PURCHASE REQUEST & APPROVAL FORM

Form Code: HSW-F32

Request Number: __________________________

Date: ____ / ____ / ______

1. REQUESTING STAFF

   1.1 Name: ___________________________________

   1.2 Department / Unit: ______________________

   1.3 Phone / Email: __________________________

2. ITEMS TO BE PURCHASED

   -------------------------------------------------------------------------------

   | No. | Item Description             | Quantity | Unit Price | Total Estimate |

   -------------------------------------------------------------------------------

   |  1  |                              |          |            |               |

   |  2  |                              |          |            |               |

   |  3  |                              |          |            |               |

   |  4  |                              |          |            |               |

   -------------------------------------------------------------------------------

   2.4 Total Estimated Cost: __________________________

3. PURPOSE

   3.1 Purpose of Purchase:

       [ ] Relic care / conservation

       [ ] Office use

       [ ] Education / outreach

       [ ] Security

       [ ] Other: _________________________________

   3.2 Short explanation:

       ___________________________________________

       ___________________________________________

4. SUGGESTED SUPPLIER (IF KNOWN)

   4.1 Supplier Name: ____________________________

   4.2 Contact / Website:

       ___________________________________________

5. APPROVAL

   Department Head:

   Name: ________________________________________

   Signature: __________________ Date: ____/____/____

   Finance / Director Approval:

   Name: ________________________________________

   Signature: __________________ Date: ____/____/____

For Finance Use:

   Purchase Order Number: _______________________