Purchase Requisition — Nile International Hospital

Purchase Requisition Form

Complete the information and obtain approvals below. Forward the completed and approved form to the Purchasing Department/Approval Max system. Forms that are not approved or incomplete will be returned to the requisitioner. All inquiries may be directed to Purchasing officer.

Requisitioner Info:

Requisition number

Date

Name

Department

Phone / Email

Delivery Department

Recommended Vendor Info:

Name

Address

Phone

Item Name	Qty	Description	Unit Price	Total
Grand Total (UGX)				0.00

Special Instructions

Department Approval:

SignatureDate

Director's Approval:

SignatureDate

Add Line Item