Conduent · Purchase Requisition

Draft #

— new —

Requester & project

Requester

Phone

Date of request

Date required

Project name

Cost center / project code

Assigned PR# (Procurement)

Assigned PO# (Procurement)

Suggested supplier

Supplier

Pick a known supplier to auto-fill its details and parts.

Contact person

Phone

Fax

Street address

Deliver to

Company

Attention

Street address

City

State

ZIP

Country

Phone

Line items

Qty

Part # / description

Unit price

Amount

Justification of purchase

Subtotal$0

Shipping / handling

Tax rate %

Total (USD)$0

Approvals

Project mgr — print name

Director — print name

Business ops — print name

CIO — print name