The document is a purchase order request form containing fields for project and customer information, requester details, supplier details, shipping details, item details including price references, and a notes section. It requests approval from two levels for the purchase of specified items that are budgeted in the Great Plains system.

1. Document No.: OPD-F-01
Purchase Order Issue.Revision: 1.2
Request Form Issue Date: 01/02/2004
Rev. Date: 12/12/2007
OPD Page: 1 of 1
PROJECT / CONTRACT INFORMATION
P.O. NUMBER CUSTOMER NAME
REQUESTER INFORMATION
BUSINESS UNIT / DEPARTMENT NAME BU / DEPT. NO. ACCOUNT NO.
REQUESTED BY 1ST LEVEL APPROVED BY 2ND LEVEL APPROVED BY
NAME
POSITION
DATE
SIGNATURE
REQUESTED ITEM(S) INFORMATION
SUPPLIER NAME :
SUPPLIER ADDRESS : CONTACT NAME : PHONE NUMBER : FAX NUMBER :
REQUESTED SHIP-TO NAME : REQUESTED SHIP-TO ADDRESS
PRICE REFERENCE (PRICE LIST ,QUOTATION) : (PLEASE SPECIFY IN DETAILS)
REQUESTED ITEMS ARE BUDGETED ON GREAT PLAINS SYSTEM AND REMAINING BUDGET WILL COVER THEM: Y/N ?
REQUESTED ITEM(S) DETAILS
SER PART NUMBER / DESCRIPTION QTY UNIT PRICE / TOTAL COST CATEGORY COMMENTS
ITEM NUMBER CURRENCY NUMBER
Notes / Special Requirements :
Confidential – Copyright © 2007, Giza Systems