SusannaDickinsonPTO
PurchaseRequestForm
Please contact [email protected] with any questions.
1) Complete the purchase request portion of this form and attach all detailed information. Please complete one form for each vendor.
2) Place this form in Dr. Mumphord’s box for approval.
3) Look for this form to be returned to you after Ms. Mumphord has approved your request.
4) Place this form in the PTO treasurer’s mail box. Please allow up to 2 weeks for purchases to be processed.
Purchase Request
Staff Name: _______________________________________ Email: ______________________________________ Date: _________________
Grade Level/Dept: ________________________________________________________Date Needed: __________________________________
Item(s) Requesting:
Cost:
1. ___________________________________________________________________________________________
$______________
2.____________________________________________________________________________________________
$______________
3.____________________________________________________________________________________________
$______________
4.____________________________________________________________________________________________
$______________
5.____________________________________________________________________________________________
$______________
6.____________________________________________________________________________________________
$______________
7.____________________________________________________________________________________________
$______________
8.____________________________________________________________________________________________
$______________
9.____________________________________________________________________________________________
$______________
10.___________________________________________________________________________________________
$______________
Total Amount requested
$______________
Item(s) to be used for: __________________________________________________________________________________________________
Vendor: ______________________________________________________________________________________________________________
□ Classroom Funds □ Grade Level Funds □ Field Trip □ Specials
□ Department: ________________________________ □ Other: ____________________________________________
Please choose a category:
FOR PTO USE ONLY:
Principal Approval:_____________________________
Dickinson Elementary PTO Purchase Request Form
PTO Approval:____________________________________
Date Updated 06/16