RHA and Hall Government

Purchase Authorization Request

Vendor: Purchase Date:

Authorization
Quantity Description of Item Estimated Cost
Name: Phone:

Campus Address:

Approver:

Title: Date:

Signature:

Approved Amount:

Assigned Purchaser:

Accounting

Line Item:

FBM:

Reconciled:

*Account(s):

* - Please provide amounts to be charges to each account. This also requires approval
signatures for both accounts.

Total: P-Card Administration

Works Approval Date: Initials:

Brief explanation of purchase:
Works Rejection Date: Initials:

Works Accounting Date: Initials:

Receipt Date: Auditor:

Note: This form must be completed prior to any purchases being made and should then be submitted to the Hall Treasurer or Advisor for approval. A separate form must be completed
for each vendor. To check out their purchase card, the purchaser must present a signed copy of this form to the appropriate staff member. It should be filed with the purchaser’s
transaction log & receipts.