Pre-purchase Authorization Form

Pre-purchase Authorization Form

This form can only be submitted by CHI Leadership
Name*

First NameLast Name
Email*
example@example.com
Item(s) to be purchased (If multiple items, please list out line by line)*
Reason for purchase*
Total Estimated Cost*
Purchase method*
Cost Center to be Used:*
Mailing Address (only if different from the address listed on W-9)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Leadership approval*
Document upload. Use if you have order details or invoice and e-mail approval from supervisor. If this is a new vendor to be paid by check or ACH, please upload the W9 here as well.

Cancelof
I attest that I have recieved leadership approval from one on the approved leaders listed prior to the purchase of the item(s) listed. I also attest that I will fill out the necessary documentation post-purchase according to the CHI Purchase Authorization Policy.
Should be Empty: