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COMMODITY & SUPPORT REQUEST
*Please list all expenditures in U.S. Dollars*
REQUESTOR INFORMATION
DATE RECEIVED
-
Month
-
Day
Year
Date
Region
LATAM
Domestic
United Board
Chapter Approver
Jonatan Gioia
Monica Puente
SOMOSLOUD CHAPTER
Please Select
Bay Area
Buenos Aires
Central Florida
Chicago
Cuidad Mexico
Dallas
Houston
Iquitos
Lima
Los Angeles
New York
Piura
Puerto Rico
San Diego
South Florida
San Diego
Tijuana
Veracruz
United Board
REQUESTOR NAME
REQUESTOR EMAIL
*
example@example.com
Request Type
*
Amazon Order
FedEx Printing
Event Support (Travel Request)
Custom Swag (local/Chapter use)
Contractual Services
Software Subscription
Name of Travelers
*
SHIP TO ADDRESS
*
For items only
ITEMS REQUESTED?
*
Rows
Item Description
Qty
Unit Price (USD)
Subtotal (auto-populates)
Link
1
2
3
4
5
6
7
8
9
10
HIDE-ITEMS REQUESTED LONG TEXT
SUBTOTAL (USD)
TAXES (USD)
GRAND TOTAL (USD)
JUSTIFICATION/NEED FOR PURCHASE OR SERVICE DESCRIPTION
*
NOTE: Services requested will require a contract if applicable
ATTACHMENTS/NOTES INCLUDED?:
NO
Yes (include details)
NOTES/DETAILS
Disclosure of Potential Conflict of Interest
Are any member(s) or related parties of SOMOSLOUD receiving financial compensation as a vendor for this event?
*
N/A - I have no conflict of interest to report
Yes - I have the below conflict of interest to report on either my behalf or that of a Chapter Board Member [please specify other nonprofit and for-profit boards you (and your spouse) sit on, any for-profit businesses for which you or an immediate family member are an officer or director, or a majority shareholder, and the name of your employer and any businesses you or a family member own.]
Name(s) of relevant SOMOSLOUD member(s) + working/vendor titles
*
Statements of Acknowledgement & Agreement
*
In accordance with the SOMOSLOUD Bylaws, I can confirm that this/these individual(s) did not take any part in the Chapter voting process for their final rate and vendor selection process.
I hereby certify that the information set forth above is true and complete to the best of my knowledge.
COI Disclosure Agreement
*
Supporting Documents
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