ON-LINE PURCHASE ORDER SERVICE FORM

Requesting Agency: Agency Phone Number:
Agency Contact Person: Agency Fax Number:
Purchase Order Number: Requisition Number:
Procurement Management Buyer:
ACTION REQUIRED ACTION
Cancel PO             Yes
Close PO to Receipting Yes
Close PO to Invoicing Yes
Authorize Price Adjustment Increase    Decrease
Change Unit Price to: $
Authorize Quantity Adjustment Increase      Decrease
Change quantity to:
Change FOB Point to: Shipping Point  Destination
Request for Reprint of Receiving Voucher Yes
Request for Reprint of Purchase Order: Yes

Explanation of Request

Agency Actions/Problems

Date Vendor Notified Name of Individual Notified Did Vendor have a problem with the request? (If yes, explain)
Yes   No
Remarks: