Club/Organization Purchase Order Funding Request

Student Club/Organization Name(Required)

Student Leader Requesting Funding(Required)

First Last

Place of Purchase(Required)

(i.e. Walmart, Target, Food City, etc.)

Please provide an accurate description, quantity, and unit price for goods desired to be purchased.

(i.e. two 36 packs of clear plastic cups from Walmart - $3.97 each)

Please provide a monetary total for all goods desired to be purchased.(Required)

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