REQUEST FOR ITEMS TO BE PURCHASED Date Requested:

1. Purchase Order Number:

2. Group requesting item(s):
3. Account to be charged: MAE Design & Manufacturing Laboratory
4. Group member issuing PO:

Vendor Information:

5. Name:
6. Address:
7. City/State/Zip:
8. Phone Number:

Description of item to be purchased: Part Number Qty. Unit Unit Price

TOTAL:

Shipping charges: Deliver to whom: Michael Braddock (392-3496)

Shipped via: Delivery location: Dept of Mech and Aero Eng.
Building C, Room 133
Denotes items to be filled in by preparer.
 Sub Total

dock (392-3496)
and Aero Eng.
oom 133