Environmental Conservation and Agricultural Enhancement Uganda

(Eco-Agric Uganda) Storehouse/ Buy Request Form

Date:

Name:

Phone Number:

Email Address:

Catalog
No.

Date Required/Needed:

Description

Unit

Quantit
y

Comments

Unit Price

Amount

Total
State Tax @ 7.25%
Shipping Charge
Grand Total

Packages are opened upon receipt and verified to the packing slip which is then retained in the office with the
order request.
Budget to Charge:

Buy Order Number:

PI Signature:

Date:

Fund Verification:

Date: