CSM Change Order Requisition Form

Requestor Name: _____________________

Date: _____________________
GUIDELINES
This form is to request a change to an established PO. It will require the same approval process as a PO.
INSTRUCTIONS
 Attach quote from vendor for requested change
 Submit to procurement@mines.edu
ORIGINAL PURCHASE
Original Purchase Order #: ____________
Vendor Name: _______________________

☐ Discretionary purchase of ≤ $50,000 for goods or services.

☐ Sole Source / DQ / IFB / RFP #_______________________________

☐ Contract ________________________

REQUESTED CHANGE
1. Please provide a detailed description on the requested change.






ACCOUNTING INFORMATION
Line #: ___________
Index: _____________ Account: ______________ Amount$: _________
Line #: ___________
Index: _____________ Account: ______________ Amount$: _________
Line #: ___________
Index: _____________ Account: ______________ Amount$: _________

APPROVAL
Approver Name: _________________________ Signature: ______________________ Date: ___________