REQ# PURCHASE REQUISITION

FORM DA29A REV 10/16	SEND TO PROCUREMENT SERVICES - THIS IS NOT AN ORDER

D E L I V E R T O	GOODS RECIPIENT:	SPECIAL HANDLING/INTERNAL INFORMATION:
DEPT.	FAX:
PHONE:	BLDG	ROOM
STREET	PO BOX	WORK ORDER/SERVICE REQUEST NO.
CITY	STATE	ZIP
SHIP VIA	F.O.B.	TERMS	VENDOR CODE	REQUIRED DELIVERY DATE
SUGGESTED SOURCES WELCOME	ACTUAL SOURCE UTILIZED	SHIP TO (IF DIFFERENT THAN “DELIVER TO”)
SALES CONTACT::
TEL:

PREVIOUS ORDER NO:

QUANTITY	UNIT	DESCRIPTION WITH CATOLG NUMBER Accurate and complete specifications will avoid delay. Please attach all necessary quotes and/or justifications.	ESTIMATED UNIT COST	ESTIMATED EXTENDED COST
$
TOTAL ESTIMATED COST	$
Req.#	CHARGE (Company Code) (Cost Object/WBS Element) (GL Code) CODE(S)

AUTHORIZED SIGNATURE_____________________________________________________DATE_______________________________________________

CONTACT PERSON________________________________ADDRESS__________________________PHONE__________________________

PURCHASE ORDER NO.___________________________BUYER’S APPROVAL__________________________ DATE___________________

Do not mail this to vendor. Send to Procurement Services. Email to procurement@duke.edu or FAX # 684-4344 – if emailing faxing DO NOT SEND ORIGINAL.

Attach quotations or justification for sole source on all purchases. This is a Federal Government requirement.

Fill out all areas on the requisition completely and correctly. This will facilitate your receipt of material.

If you have any questions please call Procurement Services at 681-5900.