Purchase Request Form

Check “Deliver To” Address:

Requested By: x Josue Alvarado Arrieta Date: x 22-Sep-23
X Nextern Costa Rica Limitada
Multitenant 2 Módulo 4. Parque La Lima, Cartago.
30106, Costa Rica Project Manager: Client PO #

Project ID/Group # Sales Order #

Purpose: x Office/EE Supplies

Department: x Process Dev. - Dept. 73

Notes: Buyer:
Ship to MN
Supplier: x Actualidad Tecnica
Contact Name: jmeza@actualidadtecnica.co.cr
Phone: 6092-1080
Email: jmeza@actualidadtecnica.co.cr
Required by Date: 31-May-23

Notes: Place mark in INSP column if parts require inspection (this includes any parts used for design verification testing).
Attach copy of supplier quote and applicable drawings, if available. Add rows if necessary.
Qty Supplier P/N Insp Nextern P/N REV Description Unit Cost Subtotal
1 Ubiquiti UniFi Switch Ubiquiti $ 1,370.00 $ 1,370.00
48 x 10/100/1000 (40 PoE+, 8
25 Nexxt Patch Cord PoE++)Cat6
Cord + 4 3Ft. BL
x 10Gb $ 125.00 $ 125.00
Ethernet SFP+ $ -
montaje en rack
PoE++ (600 W) $ -
CA 120/230 V / DC 11,5/52 V $ -
Número de parte: USW-Pro-48-
POE $ -
$ -
$ -
$ -
$ -
$ -
$ -

Total $ 1,495.00

Requestor Approver
Signature: Date: Signature: Date:
Josue Alvarado Arrieta 31-May-23 31-May-23

~Purchasing Notes~
Order Date: Order Confirmation Received:
PO #: Ship Date:

Purchase Requisition Form 1 of 1 D100518 Rev A