Capital Asset Requisition
                     Authorization for Capital Expenditure
           (Must be completed for all requests greater than $100.00)


Date:                                            

Requested By:                                                         

Department:                                                             


1)    Complete item description including accessories:                                                     
                                                                                                                          
                                                                                                                          
2)    Reason or justification for request, including use and capability:                                 
                                                                                                                          
                                                                                                                          
3)    Expected life in years:                                              
4)    Price or Lease Quotations:
                           New or
      Description          Used      Vendor         Terms       Amount
      








      


      Department Manager:                                                          

      Chief Financial Officer:                                                         

      President:                                                                          
                (Required for requests > $5,000)