Blanket Order Request	PURCH-303 3-24-04
Vendor Information (Vendor, address, phone and contact)	For Financial Services Use Only
Name	Blkt#
Address	Price
Fund
Org
Tel. #	Acct.
Fax #	Prog
Contact	Activity
Buyer
Attach list of additional sources if needed
Ship to:	1. Will Pick Up	2. Warehouse	3. Other address
If Information is not sufficient to make this purchase, request will be returned for additional information
General Description of items ordered, begin & end dates, etc.	Estimated Annual Expenditure
Purchase of the following is NOT permitted on Blanket Orders: paper Towels, Toilet Tissue, Surge Suppressors, Light Bulbs or Ballasts, Tires, Office Supplies, Diskettes, Paper, Printing or Copying, Office & Fax Machines, Furniture, Video Tape, Microsoft® software, Telephone Instruments, Capital Equipment. Blankets are limited to $ 1,000.00 in expenditures per month.	$0.00
Justify need for item
Name of Fund	Fund #	Org. #
Name	Title	Date
Signature	Tel #	Fax #
Recommended:
Supervisor’s
Signature	Date	Yes	No
Administrative Approval
Signature	Title	Date