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Requested By
Requesting Department
Date Needed (mm-dd-yyyy)
Requisition #
Purchase Order #
Select all applicable items
                            
Other Comments
Selected Vendor Info
Vendor Name
Contact Name
Order Type
Email1
Email2
Suggested Vendor (Name, Address, Phone Number)
Vendor
Bid Amount
For Internal Use Only - Does not commit NICTD to make a purchase.
Acct
Fund
Dept.
Location
Account
Pro/Veh
Grant
Line
Item(s)
Qty
Unit
Vendor Catalog/Item Desc.
NICTD Stock#
Unit Price
Ext. Price
Independent Cost Estimate (ICE)
Total
Date (mm-dd-yyyy)
Remarks
PO to be signed by C.F.O.
Attach Document (PDF, JPG, PNG, GIF, TIFF Only)


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