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2. Form Description

   This form is to be used only when a requisition is not required for the expenditure of goods and services.

4. Department Information
6. Today's Date
   Today's Date
7. Requesting Department
   -- Select One --911 CommunicationsAssigned CounselBoard of ElectionsBoard of SupervisorsClerk to the Board of SupervisorsCompliance CoronerCounty AttorneyCounty ClerkCourtsCowaselon Creek WDDepartment of Motor VehiclesDistrict AttorneyEmergency ManagementEmployment & TrainingFacilitiesFinanceHighwayHistorianInformation TechnologyMental HealthPersonnelPlanningProbationPublic HealthPublic Information OfficePurchasingReal PropertyRoad MachinerySheriff's OfficeSocial ServicesSolid WasteTreasurer's OfficeVeteran's Youth Bureau
8. Your Name
10. Vendor Information
12. Requested Effective Date of Batch
    Requested Effective Date of Batch
13. Check Run-is this PCard?
    -- Select One --yesno
14. Payment Method
    -- Select One --Check (normal)PCard
16. PCard Holder Name
17. Contract No
19. Vendor No
20. Vendor Name
22. Remit Address
23. Invoice No
25. Gross Amount
26. Description
28. Invoice Date
    Invoice Date
29. Date Invoice Received
    Date Invoice Received
30. Additional Comments
32. Account Information
34. Org
35. Object
36. Amount
38. Add'l Org
39. Add'l Object
40. Amount
42. Add'l Org
43. Add'l Object
44. Amount
46. Add Additional Org Object Amount Here
48. Add attachments
49. Add'l Attachments
50. Add'l Attachments
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field