Purchase Order Deposit/Pursuit Funding Request

Today's Date: (Day, Month, Year) *

Your Name: *

Your Email: *

Other Authorized Person: *

Their Email Address: *

Date Needed: (Day, Month, Year) *

Project Name (Street): *

Supplier Company Name (Exact): *

Supplier Contact Name (who sent proposal):

Supplier EMAIL to send PO to (who sent proposal [add their billing person if known for remittance]):

Supplier Address:

Budget (Proforma Category)

If unsure, choose Other and type description of work-finance team to determine proper coding against budget/proforma.

Budget Proforma Category - Other *

Will this cost eventually roll into the General Contractor’s contract (i.e. into GC Hard Cost)? *

Yes

No

Urgency: *

Urgency - Other: *

Exact Amount for purchase order/funding request from equity source (exclude taxes please):

If a disbursements amount is to be ADDED to PO, please specify how much (% or exact amount).

Service/Description of Work for PO: *

Upload signed proposal or contract (Max 50MB Total):

Accepted File Types: PDF, Word, Image, PowerPoint

Click or drag file(s) to this area to upload. Please choose all files at once.

Additional Details/People who need to receive PO once completed: *

Your Request has been Submitted.

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