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Paulding County School System

Purchase Requisition
This form must be prepared for all requested purchases.
Date:
Vendor:

12/1/2014

School: HHS

DELL

Program Area:

Address:

Expenditure Category (Check one category only).

City/State/Zip:
Ship to:
Address:
City/State/Zip:

X Supplies
Computer Software

Computers

702 Ballentine Drive

Books/Periodicals

Maintenance

Hiram,GA 30141

Other

Attention:

Debbie Routt

FAX NO.

770-439-5053

QBE Category (Check one category only.)


K

Principal's Signature:
Vendor copy:

Instruct. Equipment

Hiram High School

X MAILED BY CENTRAL OFFICE

Vocational Lab

Sp. Ed. III

1-3

Non-voc Lab

Sp. Ed. IV

4-5

Rem. Ed.

Media

6-8

Gifted

Staff Development

9-12

Sp. Ed. I

Other

SIA

Sp. Ed. II

ESOL

RETURN TO LOCATION

Item Number

Quantity
90

Unit
ea

Description
4 GB PC3-10600 CL( 1333 LP DDR3 240-pin DIMM
Memory Module (A5495865)
Quote #695747978
Allie Rolison

Unit Cost
47.49

Shipping & Handling


TOTAL:

For Accounting Office Use Only

Total Cost
4,274.10
$

4,274.10

Approved By:

_____________________________

Acct. #

100-4-1000-

Date:
_____________________________

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