PURCHASE REQUISITION FORM

Requestor: Date: Series No. (To be filled by procurement) :

Jerson 04/29/2023
Department: To be used in (Project Name) :
Maintenance Department Ribshack Roxas
Specific Purpose or Usage:

Freezer Repair at Ribshack Roxas

# Product/Description Qty. Unit Price Total Remarks
1 Passenger Fare (BCD-Iloilo City) 1 lot 1,500.00 1,500.00 back-and-forth
2 Passenger Fare (Iloilo City- Roxas City) 1 lot 1,500.00 1,500.00 back-and-forth
3 Miscellaneous 1 lot 3,000.00 3,000.00 back-and-forth
4 0.00
5 0.00
6 0.00
7 0.00
8 0.00
9 0.00
10 0.00
11 0.00
12 0.00
13 0.00
14 0.00
15 0.00
16 0.00
17 0.00
18 0.00
19 0.00
20 0.00
21 0.00
22 0.00
23 0.00
24 0.00
TOTAL 6,000.00
Requestor: Approved by:

Signature Signature over Printed Name / Date