NARUS, Inc. Purchase Requisition

DATE: SHIP TO: P.O. #:

VENDOR:

Y / N Purchasing Dept to Buy

Buyer Phone Call

Attention: Attention: Buyer Fax Copy of P.O.

Phone: Phone: Buyer Mail Hard Copy of P.O.

Fax: Fax: Accounting to Mail Check

Special Instructions: Requisitioner Pick Up

LINE QTY PART UNIT TOTAL DATE

ITEM REQ NUMBER PRICE PRICE Dept/Acct # REQUIRED

1

2

3

4 Shipping:

DATE REASON FOR PURCHASE Subtotal:

Name: Signature.: Tax:

DATE Total:

Name: Signature.:

DATE Ship Via:

Name: Signature.: Terms:

DATE

Name: Greg Oslan Signature.:

DATE

Name: Signature.:

DATE Budgeted Y / N

Name: Dana Mandell Signature.: Capitalize Y / N

MIS/IT DIR. (All equipment,hardware&software)

ITEM

PRESIDENT/CEO/Other

VICE PRESIDENT

DESCRIPTION

REQUISITIONER & EXT

MANAGER / DIRECTOR

(specify if different than Net 30)

CFO (All Consulting)

ORDER TO BE PLACED BY: