Request To Purchase This form is for use by Ohio governmental entities only, Vendors are not to complete or submit this form. Non-State entities should only complete this form if anticipated purchase is more than $50,000.     Auditor Login

NOTE: If this request is for an IT supply or service please submit your request to the Information Technology Procurement Services office at https://itrelease.ohio.gov.

Please click here for Frequently Asked Questions

Section 1 Contact Information
* - Required Field		*Date of Request:  05/16/2012
*Government Entity:	Make a Selection Accountancy Board Adjutant General's Office Administrative Services Air Quality Development Authority Bd of Orthotics, Prosthetics Bd of Sanitarian Registration Bd of Speech Pathology Board of Architect Examiners/Board of Landscape Architect Examiners Board of Chiropractic Examiners Board of Cosmetology Board of Embalmers and Funeral Directors Board of Engineers Board of Optometry Board of Tax Appeals Career Colleges and Schools Board Chemical Dependency Professionals Board Commission on Dispute Resolution Commission on Hisp/Latino Affairs Commission on Minority Health Counselors, Social Workers, Marriage and Family Therapists Department of Veterans Services Dept. of Natural Resources Dept. of Rehab. & Corrections Etech Ohio Commission Government Entity Job and Family Services Liquor Control Commission Manufactured Homes Commission Medical Transportation Board Motor Vehicle Collision Repair Board Natural Resources Occ Ther, Phy Ther, Ath Trainers Bd Office of Budget and Management Office of the Ohio Attorney General Ohio Arts Council Ohio Athletic Commission Ohio Board of Dietetics Ohio Board of Regents Ohio Bureau of Workers Compensation Ohio Casino Control Commission Ohio Consumers' Council Ohio Cultural Facilities Commission Ohio Department of Administrative Services Ohio Department of Aging Ohio Department of Agriculture Ohio Department of Alcohol & Drug Addiction Services Ohio Department of Commerce Ohio Department of Development Ohio Department of Developmental Disabilities Ohio Department of Education Ohio Department of Health Ohio Department of Insurance Ohio Department of Job and Family Services Ohio Department of Mental Health Ohio Department of Natural Resources Ohio Department of Public Safety Ohio Department of Rehabilitation and Corrections Ohio Department of Taxation Ohio Department of Transportation Ohio Department of Youth Services Ohio Environmental Protection Agency Ohio Ethics Commission Ohio Housing Finance Agency Ohio Industrial Commission Ohio Lottery Commission Ohio Public Defenders Ohio Public Works Commission Ohio Rehabilitation Services Commission Ohio School Facilities Commission Ohio School for the Deaf Ohio State Racing Commission Optical Dispensers Board Personnel Board of Review* Public Utilities Commission of Ohio Respiratory Care Board School for the Blind State Barber Board State Board of Psychology State Dental Board State Employment Relations Board State Library of Ohio State Medical Board of Ohio State of Ohio Board of Pharmacy University Veterinary Medical Board
*Business Unit:
*Street Address:
*City:
*State:	Ohio
*ZIP:
Contact Person:
*First Name:
*Last Name:
*Email:	(username@domain.com)
*Phone No.:	(xxx-xxx-xxxx)
Section 2 Request Information
*Provide a brief description of supplies or services to be purchased.        If this request is for the purchase of used equipment, please indicate such in the description.       (Specific details should be attached).
*Is there an existing contract for similar items/services?        (If Yes, please explain why the existing contract cannot be utilized)		Yes	No
*Please enter the date in which you will need this purchase.        (If this is an emergency purchase, please enter your reason/description.)
*Vendor quotes must be attached to the request.       Failure to attach may delay the determination of this request.		Yes (please attach price quotations)	No (please explain why not below)
*Is this a one time purchase or an on going need?		One-time needOn-going need
*Is this an MBE set-aside Purchase?		YesNo
Estimated Dollar Amount:            (e.g., $52,000.00)	Previous Annual Expenditure: (e.g., $42,000/12 months)	OAKS GL Expense Account Code:
*Fiscal Year:	*Funding Sources:
Section 3 List Known Available Sources:
Vendor Name:	(please put full vendor name)
OAK ID No.
Address:
City:
State:
ZIP Code:
This vendor is a:	ManufacturerDealerNot Sure
Vendor Name:	(please put full vendor name)
OAK ID No.
Address:
City:
State:
ZIP Code:
This vendor is a:	ManufacturerDealerNot Sure
Vendor Name:	(please put full vendor name)
OAK ID No.
Address:
City:
State:
ZIP Code:
This vendor is a:	ManufacturerDealerNot Sure
Section 4 Agency Fiscal Information:
Fiscal Contact:
*First Name:
*Last Name:
*E-Mail Address
*Phone No.	(xxx-xxx-xxxx)
Attachments:
	*Please upload attachments with a .pdf or .doc extensions.

      
      
      *Allow ten business days to receive a determination of this request.*