Capital Expenditure Request Form

Capital Expenditure Request Form
Submitter Name

First NameLast Name
Submitter Email
example@example.com
Is this a Project*

YesNo
Types of Purchase*
Branch
Regional VP *
Budgeted*

YesNo
Intended Purchase Date:*

MonthDayYear
Date
Amount Requesting to Capitalize*
Vendor*
Vehicle Description / Justification
Include all relevant information as to why this repair is being made. Include vehicle number, age, mileage, department used in, and anything else you'd like to include.
Project Name:
Project Description:
If not budgeted - Please provide commentary on need:
Resources Needed:
Project Initiator:
Project Lead:

First NameLast Name
Email:
example@example.com
Project Start Date:

MonthDayYear
Date
Estimated Completion Date:

MonthDayYear
Date
Estimated Business Disruption

MajorMediumMinimalNone
Priority

1

2

3

4

5

1 is Low, 5 is High
Services Amount:
Product Amount:
ROI (Return On Investment)

YesNo
ROI explanation if Yes:
Impact if rejected:
Attachments*

Cancelof
Should be Empty: