Purchase Requisition Form

Purchase Requisition Form

ATLAS PRODUCTION GROUP
Date of Request*

MonthDayYear
Date
Requestor

First NameLast Name
Requestor Email*
example@example.com
Type of Request*

PurchaseBudgetary / Estimate Only
Required Delivery Date (for purchase requests only)

MonthDayYear
Date
Justification (explain requirement or need for purchase)*
Supplier Name (if known)
Supplier Address (if known)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supplier Phone Number (if known)

Area CodePhone Number
Supplier Email (if known)
example@example.com
Supplier Contact Name (if known)

First NameLast Name
Supplier Contact Email (if known)
example@example.com
Contact Phone Number (if known)

Area CodePhone Number
Ref. Supplier Quotation No. (if available)
Ref. Supplier Quotation Date (if known)
APG Account*
Method of Shipment (if known)
Current FLEX Inventory Item(s)

YesNo
Add as New FLEX Inventory Item(s)

YesNo