PDR-Procurement Disbursement Requisition Change Order

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PO# and PDR#*

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Department

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Submitting Manager email*

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Type of PDR*

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Request for:*

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Item 1 Quantity:*

Item 1 Unit:*

Item 1 Unit Cost:*

Item 1 Total Cost:

Item 1 Cost Center or Project Number (10 digits)- *** IF COVID related , leave blank

Item 1 GL Account: (6 digits)*

Item 1 Short text of item/service and use*

Item 2 Quantity:

Item 2 Unit:

Item 2 Unit Cost:

Item 2 Cost Center or Project Number (10 digits)

Item 2 GL Account: (6 digits)

Item 2 Short text of item/service and use

Item 3 Quantity:

Item 3 Unit:

Item 3 Unit Cost:

Item 3 Cost Center or Project Number (10 digits)

Item 3 GL Account: (6 digits)

Item 3 Short text of item/service and use

Item 4 Quantity:

Item 4 Unit:

Item 4 Unit Cost:

Item 4 Cost Center or Project Number (10 digits)

Item 4 GL Account: (6 digits)

Item 4 Short text of item/service and use

Item 5 Quantity:

Item 5 Unit:

Item 5 Unit Cost:

Item 5 Cost Center or Project Number (10 digits)

Item 5 GL Account: (6 digits)

Item 5 Short text of item/service and use

Item 6 Quantity:

Item 6 Unit:

Item 6 Unit Cost:

Item 6 Cost Center or Project Number (10 d

Item 6 GL Account: (6 digits)

Item 6 Short text of item/service and use

Item 7 Quantity:

Item 7 Unit:

Item 7 Unit Cost:

Item 7 Cost Center or Project Number (10 digits)

Item 7 GL Account: (6 digits)

Item 7 Short text of item/service and use

Item 8 Quantity:

Item 8 Unit:

Item 8 Unit Cost:

Item 8 Cost Center or Project Number (10 digits)

Item 8 GL Account: (6 digits)

Item 8 Short text of item/service and use

Item 9 Quantity:

Item 9 Unit:

Item 9 Unit Cost:

Item 9 Cost Center or Project Number (10 digits)

Item 9 GL Account: (6 digits)

Item 9 Short text of item/service and use

Item 10 Quantity:

Item 10 Unit:

Item 10 Unit Cost:

Item 10 Cost Center or Project Number (10 digits)

Item 10 GL Account: (6 digits)

Item 10 Short text of item/service and use

Total Cost:

Justification:*

Provide a detailed description of why the goods or services are needed, when they are needed, the contract # if an open ended contract is being used, and any other pertinent information such as deposit amounts, etc. Include the name of the WCU manager who will approve the invoices. Purchasing will send a copy of the PO to the specified manager to assist them with invoice approvals.

American Institute of Architects Form Required

Delivery Instructions

Delivery- Central Receiving

Delivery- Contact Name for pick-up:

Delivery- Building

Delivery- Room #:

Delivery- Street Address

Vendor Information:

Vendor: Name, Address, and phone

Submit PDR change order for approvals*

PDR will not be sent for approval if not checked

Send me a copy of my responses

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