Change Order Request Form
Date Requested:
Submit completed forms to [email protected]. (Please add the PO # to the email subject line) If
you have any questions or need assistance, please call the Procurement Dept. @ 754-321-0505
***A CHANGE ORDER REQUEST FORM IS NOT NEEDED WHEN ADDING NEW LINES TO A PURCHASE REQUISITION***
General Information:
Requestor Name:
Requesting Dept.:
Phone Number:
Purchase Order Information:
Purchase Order #:
Purchase Requisition #:
Vendor Name:
Purchase Order (PGroup):
Requested Change(s):
PLEASE NOTE:
1. If a PO has already had an invoiced processed against it, no changes can be made
2. If closing a PO to invoice, provide the invoiced unit price for each PO line in the table provided below
3. If an item has already been received, the goods receipt must be reversed prior to any PO changes
4. For changes to a PO, provide the changes per line in the table provided below
5. A copy of the PO will not be sent to the vendor unless "Yes" is selected in the copy to vendor field
Purchase Order Type: ☐ Framework
Action Needed (Select One):
☐ Standard
Copy to Vendor:
✔
☐ Yes ☐ No
✔
If closing PO to Invoicing, reduce to:
$
(Select Action Needed from List)
Reduce Expected / Overall Value to:
$
To Change (or) Close a Purchase Order (Use the following table):
PO Line
Current
Updated
Current QTY Updated QTY
Item #
Unit Price
Unit Price
Current GL
Account
Updated GL
Account
Additional Notes Regarding Change Order Request:
Required Signatures
Director/Department Head Name:
For Procurement Use Only:
Date Request Processed:
Request Completed: ☐ Yes
☐ No
Director/Department Head Signature:
Processed By:
If no, reason not completed:
***NOTE TO PURCHASING SPECIALIST: Attach the CORF form to the Purchase Order once changes are completed.
PWS-CORF-201703
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