Capital Expenditure Request Requisition No
INSTRUCTIONS
Description: This form can be used by all departments for submitting capital expenditure
requests.
Instructions:
Step 1 Set capital approval guidelines, establish appropriate approval processes you
want to use, and communicate to your management staff.
Step 2 Complete the form as follows:
Requisition No. Leave blank; usually there will be a pre-printed
number already in this space.
Date Date of the request
Requestor Name of the requestor (Usually a manager)
Equipment Type Type of equipment (PC, phone system, etc.)
Manufacturer Requested manufacturer or vendor
Model Specific model requested
Need/Description/ Justification for the purchase
Justification
Equipment Equipment cost
Equipment Trade-In Trade in rebate (cost reduction)
Other Cost Other cost (non-equipment)
Total Project Total project cost
New Check if this is a new item
Replacement Check if this is a replacement item
Revenue Generating? Check if the item directly contributes to revenue
Budgeted? (Y or N) on whether the item is budgeted
Budget Reference # Budget reference number from the master list
Approval These sections are designated for the
appropriate signatures to approve the request.
Signature approval is normally based upon the
cost level of the capital request.
Step 3 Submit the request to the appropriate next level manager for approval or to
Purchasing if you have the approval level necessary for the purchase.
Capital Expenditure Request Requisition No. _______
(Leave blank – assigned by Purchasing)
Date: _______________________
Requestor: _______________________
Equipment Type: _______________________
Manufacturer: _______________________ Model: ________________________
Need/Description/Justification: ________________________________________________
___________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Estimated Cost Summary:
Equipment: $ __________________ New: ____
Equipment Trade-In: $ __________________ Replacement: ____
Other Cost: $ ________________ Revenue Generating? ____
Total Project: $ ________________ Budgeted? ____
Budget Reference # _____________
Approval:
Manager: _____________________ Date: _______________
COO: _____________________ Date: _______________
CIO: _____________________ Date: _______________
CFO: _____________________ Date: _______________
CEO: _____________________ Date: _______________
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Capital Expenditure Request Form
MDE_Capital Request Form.doc
MDE Enterprises
MDE_Capital Request Form.doc
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