24-25 Change Order Request

24-25 Change Order Request

Requestor Name*

Requestor Email*

Requestor Dept*

Division*

PO No.*

Vendor Name*

Is this request to change the PO $ amount?

Select

Change Order Amount*

If not requesting to increase or decrease PO, enter $0.

Original PO Amount*

Any previous change orders to this PO?*

Select

Current PO Amount*

New PO Amount after Change*

Is this request to change the account number?*

Select

Is this request to change account string only?

Select or enter value

Multiple Line Items on PO?*

Select

Line Items that need to be changed*

List change order amount for each line item*

Example 1 – Increase Line Item 1 by $25,000.00

Decrease Line Item 2 by 5,000

Example 2 - Increase Qty on line 3 (old Qty – 2, new Qty 5)

or Decrease Qty on Line 2 (old Qty 10, New Qty 5)

Will this C/O cause the PO to exceed 10K?*

Select

Did you obtain at least 3 quotes?*

Select

Has an SSJ been approved for this by Angelic?*

Select

Do you have backup documentation for this C/O?*

Select

File Upload*

Drag and drop files here or

Fund 11000?

Original Account String*

If you have more than one account string, please list each account string that requires changes here (one per line).

New Account String*

If you have more than one account string, please list each account string that requires changes here (one per line).

Special Instructions

Please list any special instructions for your request.

For example - If you have multiple account strings, please list the changes/allocations by each account string.

41032-701375-612400-710000 - add $5,000

49100-701375-613400-710000 - deduct $1,000

Is there sufficient budget in this account?*

Please confirm that there are sufficient funds for this change in the account you are utilizing. If there are not sufficient funds, please complete a Budget Transfer.

Select

Please enter JV# for budget transfer*

Reason for Change Order*

Is this grant funded?*

Select

Please provide the Fund # and name*

Grant funding deadline to encumber*

Grant funding deadline to receive goods/services*

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