Requisition
Kanawha County Commission					For Purchasing use Only
Form 01-Req     (Revised 2002)					Requisition No.
KANAWHA COUNTY COMMISSION
Purchase Requisition
Vendor Name & Address:					Line item No.:
					Using Agency:
					Date:
					Page:	of
					UNIT
ITEM	U.M.	QUANTITY	DESCRIPTION		PRICE	AMOUNT
				TOTAL
$1.00-$999.00 - Three telephone quotes recorded below are required; $1,000.00-$4,999.00 three
written quotes attached hereto are required; $5,000.00 or more must be publicly bid (Contact
Purchasing for assistance: 357-0115)
VENDOR:		VENDOR:		VENDOR:
Item #	Unit Price	Item #	Unit Price	Item #	Unit Price
			I hereby certify that the above information is true and correct, and complies
			in all respects to county purchasing policies and procedures (as amended)
			Signature--Authorized Requisitioner		Date