CURE Purchase Request Form

Instructions:

Fill out this form in its entirety for purchases between $0-$4,999.
Please upload the vendor quote or screenshot of the online shopping cart with the itemized total that includes shipping (gif, jpg, png, or pdf).
Recalculate the tax using 8.75% (SRJC will pay tax at 8.75% even if the vendor quotes a different tax rate, or no tax at all).
Use the Notes/Special Instructions to note any special instructions.
For reimbursement of items that were purchased out of pocket please upload a copy of the receipt and submit the original receipt to Tami Meraz in Bussman Hall, 1496. Also, indicate in the Notes/Special Instructions that it is a reimbursement.
For questions please contact Tami Meraz at tmeraz@santarosa.edu.

First Name: *

Last Name: *

Vendor Name: *

Email the Vendor Quote to tmeraz@santarosa.edu

Delivery: *

Warehoue Receiving

You Pick Up

Subtotal: *

Tax (8.75%): *

Shipping: *

Total: *

Notes/Special Instructions:

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