Request for PICM Purchases (PICM Staff Only)

Date of Request

First Name :

Last Name :

Email :

Phone :

Item(s) to be purchased:

Justification:

You must provide itemized receipts for reimbursement or payment. Remember that the college DOES NOT pay sales tax. You will not be reimbursed for any sales tax paid. Be sure to tell the vendor that this is a tax exempt purchase and give them the tax ID number. If you do not have the tax number contact PICM.

Amount of Purchase :

Method of payment :

Account number :

Approximate cost
$25
$50
$75
$100
$150
$200
$300
Other :

Budget Authority and Requestor Information

Approved by (Budget Authority)

Budget Authority Email

Budget Authority Phone

Date of Approval