ࡱ> 130Y bbjbjWW /==p]FFFF$@ kkk       $  + kkkk+ FFk@FR FFFFk * " AkH~0  INSTRUCTIONS Description: This form can be used by all departments for submitting capital expenditure requests. Instructions: Step 1 Set capital approval guidelines, establish appropriate approval processes you want to use, and communicate to your management staff. Step 2 Complete the form as follows: Requisition No. Leave blank; usually there will be a pre-printed number already in this space. Date Date of the request Requestor Name of the requestor (Usually a manager) Equipment Type Type of equipment (PC, phone system, etc.) Manufacturer Requested manufacturer or vendor Model Specific model requested Need/Description/ Justification for the purchase Justification Equipment Equipment cost Equipment Trade-In Trade in rebate (cost reduction) Other Cost Other cost (non-equipment) Total Project Total project cost New Check if this is a new item Replacement Check if this is a replacement item Revenue Generating? Check if the item directly contributes to revenue Budgeted? (Y or N) on whether the item is budgeted Budget Reference # Budget reference number from the master list Approval These sections are designated for the appropriate signatures to approve the request. Signature approval is normally based upon the cost level of the capital request. Step 3 Submit the request to the appropriate next level manager for approval or to Purchasing if you have the approval level necessary for the purchase.   Capital Expenditure Request Requisition No. _______ (Leave blank assigned by Purchasing) Date: _______________________ Requestor: _______________________ Equipment Type: _______________________ Manufacturer: _______________________ Model: ________________________ Need/Description/Justification: ________________________________________________ ___________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________  Estimated Cost Summary: Equipment: $ __________________ New: ____ Equipment Trade-In: $ __________________ Replacement: ____ Other Cost: $ ________________ Revenue Generating? ____ Total Project: $ ________________ Budgeted? ____ Budget Reference # _____________  Approval: Manager: _____________________ Date: _______________ COO: _____________________ Date: _______________ CIO: _____________________ Date: _______________ CFO: _____________________ Date: _______________ CEO: _____________________ Date: _______________ Capital Expenditure Request Form MDE_Capital Request Form.doc MDE Enterprises MDE_Capital Request Form.doc  %Q]:>Yb (9aosv"ALu C K ī CJ OJQJ5CJ OJQJ5B* CJ OJQJ jU55B* CJOJQJ CJOJQJ5CJOJQJ5CJOJQJ5B* CJ(OJQJj5B* CJ(OJQJUmH@uS{7V%Zos>ruS{7V%Zos>r? @ u r < _ ( ) uSJKwx7345[;? @ u r < _ ( ) ux 1 _ d ) 6 ` f  !#:;RTBCIJac'(3<=ABb嶮5B* CJOJQJ CJOJQJ5CJOJQJ jUmHCJCJ>*CJOJQJ5>*CJOJQJjCJOJQJUmHCJ CJOJQJ5CJOJQJOJQJ CJOJQJ9u "#;<IJ')3;<= "#;<IJ')3;<=01AB_`ab    efg 78PQST'01AB_`ab / =!"#$%nDbw]1fn8txPNG  IHDRf{gAMA+IDATx(=Nb61O^zwx*W1(wy<܈:ȁ@:`x]]R0?:`H A 0t ^a)LjS-ہ9j`~&*ED$eyoc1s0+۫m,kdnQâeyby;͆Z[y$C{l? 7iN{>:kdZ̡@7i|a2w?+l̰hn5VpU%ے,^qVrd,9$A֔)4k2Qa7*N1>F^3&lKZTK*nh,#uX8j@pW9%X]{6 |'-1;9gb\7!.'G\IC0AsP|־Ex9ާ?ǑNfa YV-T\@Srpd,gd\4WBfޛv̦+̷:;{s͙n0L6U2+]K08啵|)F1%k*L ؼ]ppy>ILxЭ( ++,֬&ňr}4zfZőPƘqzœ֕3j&@2Fx][Tt Yp<00oWw'XG4/0;23iRT3ma .b1oi2Ox3,TOܸ/7zw|V$f\J2dHRU3-D$X0 I^`! 2t^uV3&HP* HSޡH#," mSC7[2Xڨ5[76?sP e+%i^5h2V%߮IKh N~\-yo#wPD""840-9wO&1ru}!u>5\"Fje#`IgM7a[h/wf^+`Ntl28H A 0eɽf2XR8 |o̓$3F:>y6f94dh/1c2\aۨUhgſ<7EbK|9f)Q}|eO󼅹I?AV$a00"ٽf:$6_$dLOWp3vK7zT4f7lnU^'Ww $( ;p=YTxG]̎Y bfc<c^fCx_F:zNVGA {1g8N@=C:I6.iKN^ޡ9 [o) 𒖹%Ȣz6\.Ѭ@:tC3SV<{'lNy3k%@:嬧0E*OgͬcςoLFUR'He.Mdw9.^g%zTvL8Uf{a%xq@.10L t @:`9%@|` 6AtXt KP/LʶIENDB` [$@$NormalmH 8@8 Heading 1$@& CJOJQJ>@> Heading 2$@&5B* CJOJQJ>@> Heading 3$@&56CJOJQJ<A@<Default Paragraph Font@ob@orb( b ub bl,b$Dbw]1fn8tx(@:( (! 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