Capital Appropriation Request [ CREATION MODE ]

Custom Transaction Data

EQUIPMENT INFORMATION

Equipment Name:
Function:
Quantity:
Useful Life:


If purchase is replacement for existing equipment, state the existing equipment Capital Asset Number
Capital Asset Number:
Plans for disposition of existing equipment:

SUGGESTED SUPPLIER			ALTERNATE SUPPLIER

Company Name:			Company Name:
Address:			Address:

City, State, Zip:			City, State, Zip:
Contact:			Contact:
Telephone:			Telephone:

CAPITAL COST IMPACT Suggested Supplier			CAPITAL COST IMPACT Alternate Supplier

Quoted Price ($):			Quoted Price ($):
Site Preperation Cost ($):			Site Preperation Cost ($):
Installation Cost ($):			Installation Cost ($):
Currency Exchange ($):			Currency Exchange ($):
Freight ($):			Freight ($):
Duty ($):			Duty ($):
Taxes ($):			Taxes ($):
Other Costs ($):			Other Costs ($):
Sub Total ($):			Sub Total ($):
Less Trade-In / Sale Proceeds ($):			Less Trade-In / Sale Proceeds ($):
Outstanding Funding ($):			Outstanding Funding ($):
Total Capital Cost ($):			Total Capital Cost ($):

OPERATING COST IMPACT

	Present Cost	Projected Cost	Net impact Cost/Savings($)
Salaries →
Supplies →
Service Contract →
Other →

TOTAL OPERATING COST / SAVING IMPACT($):

JUSTIFICATION FOR PURCHASE

Please provide justification for capital equipment purchase:


Related Workflow Route