For U of A-Cooperative Extension Service employees only
Request for Reimbursement For Item(s) or Service(s) not on State Contract	PURCH-330 Rev. 6-14
I certify that this claim is true and correct and that the purchase was solely in support of a Cooperative Extension Service Program or Activity.
Date	Item	Vendor	Amount
Total	$0.00
Reason	Demonstration materials for EFNEP
Use for special project/grant (identify)
Other (specify)
Fund #	Org. #
Make check payable to:
Signature (not stamped)	Date
Typed Name and Title
Employee I.D.	Location
Signature of Supervisor	Date
Signature of Project
Director	Date
(If purchase is made from grant funds)
1.	Submit original Form PUCH-330 and the original itemized receipt(s). Cash register tapes will not be accepted unless they are itemized.
2.	Receipt must indicate item purchased, unit cost (per pound, per pair, etc.) and total cost.
3.	See CESP 10-1 for detailed instructions.